ADVANCED VASCULAR THERAPY LLC (NPI# 1356726418) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356726418 |
| Entity Type | Organization |
| Organization Name | ADVANCED VASCULAR THERAPY LLC |
| Practice Address |
2480 Liberty St Ne Suite 110 Salem OR 97301-8380 |
| Practice Telephone | 5033711756 |
| Mailing Telephone | 5033711756 |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2015-11-20 |
| Authorized Official Name | GLEN S ROSEBOROUGH (DIRECTOR) |
| Authorized Official Telephone | 5033711756 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
MD150190 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 599512556 | 05 |
| Street Address |
2480 LIBERTY ST NE SUITE 110 |
| City | SALEM |
| State | OR |
| Zip Code | 97301-8380 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881694792 | Willamette Spine Center Ambulatory Surgery LLC | Clinic/Center | 2480 Liberty St Ne, Suite 120, Salem, OR 97303-6780 | 2005-07-21 |
| 1912308404 | Nash William Keene | Physician Assistant | 2480 Liberty St Ne, Suite 180, Salem, OR 97301-8380 | 2014-09-16 |
| 1326464181 | Janelle Zych | Physical Therapist | 2480 Liberty St Ne, Suite 140, Salem, OR 97301 | 2014-03-17 |
| 1336411636 | Donald Edwin Winder Jr. | Physician Assistant | 2480 Liberty St Ne, #110, Salem, OR 97301-8380 | 2012-02-01 |
| 1235466772 | Jessica Lauren Visintainer | Physical Therapist | 2480 Liberty St Ne, Ste 140, Salem, OR 97301-8380 | 2009-11-04 |
| 1023243474 | Pain Care Specialists, PC | Anesthesiology | 2480 Liberty St Ne, Suite 180, Salem, OR 97301-8380 | 2009-05-28 |
| 1982841565 | Priscilla Anne Walters | Social Worker | 2480 Liberty St Ne, Salem, OR 97301-8380 | 2009-01-19 |
| 1992999536 | Pacific Spine & Rehab, LLC | Clinic/Center | 2480 Liberty St Ne, Ste 180, Salem, OR 97301-8388 | 2007-08-28 |
| 1932310216 | Alyce M. Huntsinger | Nurse Practitioner | 2480 Liberty St Ne, Suite 180, Salem, OR 97301-8380 | 2007-05-25 |
| 1255421467 | Poly Chen | Anesthesiology | 2480 Liberty St Ne, Suite 110, Salem, OR 97301-8380 | 2006-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205450970 | Jehan Seals | Behavior Technician | 3400 State St Set G750, Salem, OR 97301 | 2020-05-29 |
| 1093335929 | Sterling Recovery, LLC | Dietitian, Registered | 3758 Amber St Ne #105, Salem, OR 97301 | 2020-04-21 |
| 1760018360 | Riverfront Mental Health LLC | Counselor | 338 State St, Suite 985, Salem, OR 97301 | 2020-03-16 |
| 1871126888 | Amity Beth Haddon Maxwell | Social Worker | Oregon State Hospital, 2600 Center St Ne, Salem, OR 97301 | 2020-02-18 |
| 1861042632 | Brenda Grizelda Vargas | Behavioral Analyst | 3400 State Ste Ste G750, Salem, OR 97301 | 2019-09-13 |
| 1588213177 | Natalie Stone | Registered Nurse | 2045 Siverton Rd Ne, Salem, OR 97301 | 2019-09-06 |
| 1588228720 | Jeramy Disenso | Counselor | 270 Cottage St Ne, Salem, OR 97301 | 2019-04-23 |
| 1801353297 | Gwendolyn Kersey | Registered Nurse | 2600 Center St Ne Oregon State Hospital, Salem, OR 97301 | 2019-02-21 |
| 1841769114 | Spine Clinic PC | Massage Therapist | 1281 Lancaster Drive Ne, Salem, OR 97301 | 2018-11-16 |
| 1013482132 | Kellie Linn Hansen | Physical Therapist | 4049 Market St Se, Salem, OR 97301 | 2018-10-04 |
| Find all providers in zip 97301 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225351901 | Willamette Vascular Specialists, PC | Surgery | 1015 25th St Se, Salem, OR 97301 | 2010-03-09 |
| 1174756605 | Benjamin R. Wilson, Md, PC | Surgery | 700 Bellevue Street, Suite 240, Salem, OR 97301-3855 | 2009-09-01 |
| 1508074147 | Salem Vascular Consultants, LLP | Surgery | 1535 Liberty St Se, Salem, OR 97302-4345 | 2007-05-18 |
| 1215215371 | Atish Chopra | Surgery | 665 Winter St Se, Salem, OR 97301-3934 | 2011-07-23 |
| 1003106071 | Jeffrey David Crawford | Surgery | 665 Winter St Se, Salem, OR 97301-3934 | 2011-04-12 |
| 1831411560 | Salem Vascular, PC | Surgery | 1535 Liberty St Se, Salem, OR 97302-4345 | 2010-02-22 |
| 1326207739 | Amani D Politano | Surgery | 875 Oak St Se Ste 5020, Salem, OR 97301-3997 | 2008-06-02 |
| 1104990175 | Rick Dewitt Pittman | Surgery | 1793 13th St Se, Salem, OR 97302-2541 | 2006-11-20 |
| 1003980053 | Mark Steven Peterson | Surgery | 925 Commercial St Se Ste 102, Salem, OR 97302-4173 | 2006-11-20 |
| 1578596938 | William Siao-ping Tung | Surgery | 1802 Braeburn Dr, Salem, VA 24153-7357 | 2006-07-09 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.