MEDICARE: VASCULAR INSTITUTE OF COLUMBUS, 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	:	1891343315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VASCULAR INSTITUTE OF COLUMBUS, LLC.

Provider Business Mailing Address
First Line	:	6503 E BROAD ST STE 200
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1693
Country	:	US
Telephone Number	:	614-810-1300
Fax Number	:	614-810-1301

Provider Business Practice Location Address
First Line	:	6503 E BROAD ST STE 200
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1693
Country	:	US
Telephone Number	:	614-810-1300
Fax Number	:	614-810-1301

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SARA ARREDONDO
Credential	:
Telephone Number	:	614-810-1300

Provider Enumeration Date	:	08/28/2019
Last Update Date	:	04/08/2020

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