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General NPI Number Information
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NPI Number | 1326430497
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Entity Type | Organization
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Legal Business Name | VASCUCARE PC
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 3530 E SPAULDING AVE
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City | PUEBLO
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State | CO
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Zip | 81008-2209
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Country | US
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Telephone | 719-296-0023
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Fax | 719-296-9001
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Provider Business Mailing Address
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Address Line | 3530 E SPAULDING AVE
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City | PUEBLO
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State | CO
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Zip | 81008-2209
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Country | US
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Telephone | 719-296-0023
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Fax | 719-296-9001
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JOHN MEHALL
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Credential |
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Telephone | 719-776-7602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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