Provider Demographics
NPI:1730799347
Name:WARREN ENDOVASCULAR ASSOCIATES LLC
Entity type:Organization
Organization Name:WARREN ENDOVASCULAR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:VITVITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:304-374-7754
Mailing Address - Street 1:330 RED ROCK RUN
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9491
Mailing Address - Country:US
Mailing Address - Phone:304-374-7754
Mailing Address - Fax:330-451-5764
Practice Address - Street 1:1950 NILES CORTLAND RD NE STE 12
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1077
Practice Address - Country:US
Practice Address - Phone:330-282-6301
Practice Address - Fax:330-451-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.082483OtherMEDICAL LICENSE
OH0143870Medicaid
1578507299OtherNPPES