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NPI Code Detail

MEDICARE: ADVANCED VASCULAR CARE INC

MEDICARE: ADVANCED VASCULAR CARE INC
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
1208600000XSurgery Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11063852192OTHERNPI
214V4QOTHERBC
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518338565
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED VASCULAR CARE INC
Provider Business Mailing Address
First Line : 4516 E HIGHWAY 20
Second Line : SUITE 226
City : NICEVILLE
State : FL
Zip : 32578-9755
Country : US
Telephone Number : 305-662-5200
Fax Number : 305-284-7913
Provider Business Practice Location Address
First Line : 2010 LEWIS TURNER BLVD
Second Line :
City : FORT WALTON BEACH
State : FL
Zip : 32547-1352
Country : US
Telephone Number : 305-662-5200
Fax Number : 305-284-7913
Authorized Official
Title or Position : MEDICAL CLAIM SPECIALIST
Name : DEBBIE JEAN ANDERSON
Credential : CIMCS
Telephone Number : 850-543-8960
Provider Enumeration Date : 10/16/2015
Last Update Date : 01/15/2016

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Directions to “ADVANCED VASCULAR CARE INC ” Practice Location

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