MODERN VASCULAR OF SOUTHAVEN, LLC is a vascular and interventional radiology radiology in Southaven, MS. The provider is a radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. MODERN VASCULAR OF SOUTHAVEN, LLC NPI is 1174171441. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider's business location address is:
55 PHYSICIANS LN
SOUTHAVEN, MS
ZIP 38671-569
Phone: (662) 655-2136
Fax: (662) 996-2214
The provider's authorized official is Yury Gampel .
The authorized official title is Manager and has the following contact phone number (818) 880-8605.
The CLIA number assigned to this NPI record is 25D2182554 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 8/29/2019 and was last updated on 8/29/2019.