MEDICARE: PREFERRED VASCULAR SERVICES AKRON, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician
2	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1114604105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREFERRED VASCULAR SERVICES AKRON, LLC

Provider Business Mailing Address
First Line	:	9140 CORSEA DEL FONTANA WAY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-4397
Country	:	US
Telephone Number	:	239-597-2010
Fax Number	:	239-597-2313

Provider Business Practice Location Address
First Line	:	43 S MAIN ST STE 1
Second Line	:
City	:	MUNROE FALLS
State	:	OH
Zip	:	44262-1635
Country	:	US
Telephone Number	:	234-349-8100
Fax Number	:	239-597-2313

Authorized Official
Title or Position	:	CFO
Name	:	LISA MCNAMARA
Credential	:	CFO
Telephone Number	:	239-597-2010

Provider Enumeration Date	:	06/30/2023
Last Update Date	:	06/30/2023

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