# VASCULAR CENTER & VEIN CLINIC OF SOUTHERN INDIANA

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

## Provider details

- **NPI number:** 1346369287
- **Authorized official:** DR. RICARDO VASQUEZ MD (PRESIDENT)
- **Authorized official phone:** (812) 336-6008

## Contact information

- **Practice address:** 815 W 2ND ST, BLOOMINGTON, IN 47403-2212
- **Practice address phone:** (812) 336-4947
- **Practice address fax:** (812) 339-6947
- **Mailing address:** 815 W 2ND ST, BLOOMINGTON, IN 47403-2212
- **Mailing address phone:** (812) 336-6008
- **Mailing address fax:** (812) 339-6947

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 01062063A | IN | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 12/10/2008

## 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 |