Third Coast Vascular ASC LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

THIRD COAST VASCULAR ASC LLC

Practice address

1441 N Taylor Dr
Sheboygan, WI 53081-1989

Phone

(262) 577-0250

Fax

(262) 577-0251

NPI assigned

Mar 20, 2023

Last updated

Mar 20, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Taha Siders, MD

Title

Chief Operating Officer

Phone

(262) 577-0250

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952003618. Details of each certification follow.

• CCN 52C0001156 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 52C0001156

Legal name

Third Coast Vascular ASC LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jan 9, 2025

Last certification

Jan 9, 2025

Ownership / control type

Proprietary

Facility address

1441 N. Taylor Dr.
Sheboygan, WI 53081

Locations

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.

• Christopher L Larson

  • Ophthalmology Physician
  • Sheboygan, WI
  • NPI 1750358693
  Medicare reassignment NPD
• Todd Robert Larson, D.O.

  • Ophthalmology Physician
  • Sheboygan, WI
  • NPI 1609184365
  Medicare reassignment NPD
• Awais H Siddique, MD

  • Vascular & Interventional Radiology Physician
  • Milwaukee, WI
  • NPI 1649387846
  Medicare reassignment NPD

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1952003618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W LAYTON AVE STE 40",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532215420",
            "telephone_number": "262-577-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 N TAYLOR DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811989",
            "telephone_number": "262-577-0250",
            "fax_number": "262-577-0251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRD COAST VASCULAR ASC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "SIDERS",
        "authorized_official_first_name": "TAHA",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "262-577-0250",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• These Are Choices LLC
• Doris U Theune, MS RN CS
• Ariana Marie Theys
• Jennifer L Thickens, APNP-BC
• Taylor Leigh Thielke, LMT
• Third Coast Vascular SC
• Jerome E Thomas, CRNA
• Tarun Rajan Thomas
• Gregory Conrad Thompson, D.O.
• Mitchell James Thompson, DPM

• Ambulatory Surgical Clinic/Center in Sheboygan, WI
• Providers in Sheboygan, WI by specialty
• Ambulatory Surgical Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.