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General NPI Number Information
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NPI Number | 1659898096
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY VASCULAR ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/26/2017
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Last Update Date | 08/26/2017
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Provider Practice Location Address
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Address Line | 13303 TESSON FERRY RD STE 105
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City | SAINT LOUIS
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State | MO
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Zip | 63128-4062
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Country | US
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Telephone | 314-270-8540
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 PALM HARBOR BLVD STE A
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City | PALM HARBOR
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State | FL
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Zip | 34683-1930
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Country | US
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Telephone | 727-474-0090
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JANET R DEES
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Credential |
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Telephone | 727-474-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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