# THIRD COAST VASCULAR ASC LLC

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

## Provider details

- **NPI number:** 1952003618
- **Authorized official:** TAHA SIDERS MD (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (262) 577-0250

## Contact information

- **Practice address:** 1441 N TAYLOR DR, SHEBOYGAN, WI 53081-1989
- **Practice address phone:** (262) 577-0250
- **Practice address fax:** (262) 577-0251
- **Mailing address:** 2500 W LAYTON AVE STE 40, MILWAUKEE, WI 53221-5420
- **Mailing address phone:** (262) 577-0250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/20/2023
- **Last updated:** 03/20/2023