MEDICARE: ADVANCED VASCULAR SOLUTIONS, 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	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1689429219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED VASCULAR SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	1250 S HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3242
Country	:	US
Telephone Number	:	321-725-8919
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 S HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3242
Country	:	US
Telephone Number	:	321-725-8919
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	STEPHANIE CAMPION
Credential	:
Telephone Number	:	772-581-8900

Provider Enumeration Date	:	04/18/2024
Last Update Date	:	04/18/2024

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