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Contact Information

MODERN VASCULAR OF SOUTHAVEN, LLC
55 PHYSICIANS LN
SOUTHAVEN, MS38671-9569
 Phone: 662-655-2136
 Fax: 662-996-2214
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Vascular & Interventional Radiology

2085R0204X 94 Physician/Interventional Radiology
 

Vascular-Interventional Technology Radiologic Technologist

2471V0106X
Indicates primary specialty

NPI Profile & details for MODERN VASCULAR OF SOUTHAVEN, LLC

NPI Number 1174171441
LBN Legal business name MODERN VASCULAR OF SOUTHAVEN, LLC
Authorized official YURY GAMPEL - (MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/29/2019
Last updated 08/29/2019 - About 7 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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