ADVANCED VASCULAR THERAPY LLC NPI 1356726418

NPI Information

NPI: 1356726418
Provider Name: ADVANCED VASCULAR THERAPY LLC
Classification: Surgery - 2086S0129X
Entity Type: Organization

Specialization: Vascular Surgery

Address:
2480 LIBERTY ST NE
SUITE 110
SALEM, OR
ZIP 97301
Phone: (503) 371-1756
Get Directions

ADVANCED VASCULAR THERAPY LLC is a vascular surgery surgery in Salem, OR. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. ADVANCED VASCULAR THERAPY LLC NPI is 1356726418. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2480 LIBERTY ST NE
SUITE 110
SALEM, OR
ZIP 97301-380
Phone: (503) 371-1756

The provider's authorized official is Glen S Roseborough .
The authorized official title is Director and has the following contact phone number (503) 371-1756.

The enumeration date for this NPI number is 7/29/2015 and was last updated on 11/20/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0129X	Surgery	Vascular Surgery	MD150190	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	599512556	MEDICAID	OREGON
2	H25149	MEDICARE UPIN	OREGON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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