Provider Demographics
NPI:1861929606
Name:PANHANDLE VASCULAR SURGICAL SPECIALISTS
Entity type:Organization
Organization Name:PANHANDLE VASCULAR SURGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINCOLN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-437-3777
Mailing Address - Street 1:1502 CREIGHTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7143
Mailing Address - Country:US
Mailing Address - Phone:850-437-3777
Mailing Address - Fax:850-437-3318
Practice Address - Street 1:1502 CREIGHTON RD STE A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7143
Practice Address - Country:US
Practice Address - Phone:850-437-3777
Practice Address - Fax:850-437-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty