Provider Demographics
NPI:1689429219
Name:ADVANCED VASCULAR SOLUTIONS, LLC
Entity type:Organization
Organization Name:ADVANCED VASCULAR SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-581-8900
Mailing Address - Street 1:1250 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3242
Mailing Address - Country:US
Mailing Address - Phone:321-725-8919
Mailing Address - Fax:
Practice Address - Street 1:1250 S HARBOR CITY BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3242
Practice Address - Country:US
Practice Address - Phone:321-725-8919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty