Provider Demographics
NPI:1053336701
Name:THE VASCULAR MEDICAL CENTER INC
Entity type:Organization
Organization Name:THE VASCULAR MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-292-5151
Mailing Address - Street 1:1219 HIDDEN MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-3640
Mailing Address - Country:US
Mailing Address - Phone:858-292-5151
Mailing Address - Fax:
Practice Address - Street 1:1550 PEPPER DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4165
Practice Address - Country:US
Practice Address - Phone:760-353-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG340Medicare UPIN