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Organization
VASCULAR CENTER & VEIN CLINIC OF SOUTHERN INDIANA
Active
Organization
VASCULAR CENTER & VEIN CLINIC OF SOUTHERN INDIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICARDO VASQUEZ MD (PRESIDENT)
(812) 336-6008
Entity
Organization
Contact information
Practice address
815 W 2ND ST, BLOOMINGTON, IN 47403-2212
(812) 336-4947
(812) 339-6947
Mailing address
815 W 2ND ST, BLOOMINGTON, IN 47403-2212
(812) 336-6008
(812) 339-6947
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
01062063A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200818170
MEDICAID GROUP
IN
01
—
200818170A
MEDICAID INDIVIDUAL
IN
01
—
250940
MEDICARE GROUP
IN
01
—
250940A
MEDICARE INDIVIDUAL
IN
01
—
517966
ANTHEM
IN
01
—
DF9011
MEDICARE RAILROAD GROUP
IN
01
—
P00400660
MEDICARE RAILROAD INDIVIDUAL
IN
Enumeration date
03/29/2007
Last updated
12/10/2008
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