NPIMap

Organization Active NPI

The Vascular and Interventional Group, LLC

  • Vascular & Interventional Radiology Physician
  • Wilsonville, OR
National Provider Identifier
1265908289
Registry record updated Oct 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
THE VASCULAR AND INTERVENTIONAL GROUP, LLC
Practice address
25030 SW Parkway Ave Ste 200
Wilsonville, OR 97070-9816
Phone
(503) 612-0498
Fax
(503) 459-0521
NPI assigned
Oct 17, 2018
Last updated
Oct 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mandy Bouschor
Title
Administrator
Phone
(503) 612-0498

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X NU Primary

Addresses

Primary practice location

25030 SW Parkway Ave Ste 200
Wilsonville, OR 97070-9816

Mailing address

25030 SW Parkway Ave Ste 200
Wilsonville, OR 97070-9816
Phone (503) 612-0498

National Provider Directory

National Provider Directory

Locations

25030 SW Parkway Ave
Ste 200
Wilsonville, OR 97070
Phone (503) 612-0498

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539734400000",
    "number": "1265908289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25030 SW PARKWAY AVE STE 200",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709816",
            "telephone_number": "503-612-0498",
            "fax_number": "503-459-0521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25030 SW PARKWAY AVE STE 200",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709816",
            "telephone_number": "503-612-0498",
            "fax_number": "503-459-0521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VASCULAR AND INTERVENTIONAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-17",
        "last_updated": "2018-10-17",
        "status": "A",
        "authorized_official_last_name": "BOUSCHOR",
        "authorized_official_first_name": "MANDY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "503-612-0498"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilsonville, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.