Modern Vascular of St Louis LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

MODERN VASCULAR OF ST LOUIS LLC

Practice address

641 N New Ballas Rd
Creve Coeur, MO 63141-6713

Phone

(314) 648-0101

Fax

(314) 899-2715

NPI assigned

Nov 18, 2020

Organization subpart

No

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

Authorized official

Name

Yury Gampel

Title

Ceo

Phone

(818) 880-8605

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1605657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1972106391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26500 AGOURA RD STE 102-587",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "913021952",
            "telephone_number": "818-880-8605",
            "fax_number": "818-579-7916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "641 N NEW BALLAS RD",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631416713",
            "telephone_number": "314-648-0101",
            "fax_number": "314-899-2715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN VASCULAR OF ST LOUIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-18",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "GAMPEL",
        "authorized_official_first_name": "YURY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-880-8605"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2471V0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiologic Technologist, Vascular-Interventional Technology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vascular & Interventional Radiology Physician in Creve Coeur, MO
• Providers in Creve Coeur, MO by specialty
• Vascular & Interventional Radiology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; 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.