# VASCULAR INTERVENTIONAL & PAIN CLINIC-VIP CLINIC-VIP IMAGING CEN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215433974
- **Authorized official:** MAHMOUD SAMMAN MD (DIRECTOR/OWNER)
- **Authorized official phone:** (502) 533-3919

## Contact information

- **Practice address:** 3906 S DUPONT SQ STE A, LOUISVILLE, KY 40207
- **Practice address phone:** (502) 533-3919
- **Practice address fax:** (440) 332-3844
- **Mailing address:** PO BOX 1328, PROSPECT, KY 40059-1328
- **Mailing address phone:** (859) 393-3124
- **Mailing address fax:** (440) 332-3844

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | Yes |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/02/2018
- **Last updated:** 08/23/2021