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General NPI Number Information
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NPI Number | 1568352771
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Entity Type | Organization
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Legal Business Name | VASCULAR INSTITUTE MS SURGERY CENTER LLC
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 200 DECK STONE DR
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City | BATESVILLE
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State | MS
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Zip | 38606-1097
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Country | US
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Telephone | 901-390-2930
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Fax |
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Provider Business Mailing Address
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Address Line | 6409 N QUAIL HOLLOW RD
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City | MEMPHIS
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State | TN
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Zip | 38120-1414
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Country | US
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Telephone | 901-390-2930
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Fax | 901-390-2940
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Authorized Official
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Title or Position | CO-OWNER
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Name | PRATEEK GUPTA
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Credential | MD
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Telephone | 901-390-2930
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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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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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