Basic Information
| Provider Information | |||||||||
| NPI: | 1497797401 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VACCA | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 REID PARKWAY | ||||||||
| Address2: | MEDICAL STAFF SERVICES | ||||||||
| City: | RICHMOND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7659358802 | ||||||||
| FaxNumber: | 7659833219 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 JACKSON ST STE A | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453311396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3754722129 | ||||||||
| FaxNumber: | 9375473066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036105971 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 036105971 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 036105971 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 02004966A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 34.005077 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 264630 | 01 | IL | HEALTHLINK | OTHER | 036105971 | 05 | IL | MEDICAID | 290014938 | 01 | IL | MEDICARE RAILROAD | OTHER | 081851 | 01 | IL | HEALTH ALLIANCE | OTHER | 300046415 | 05 | IN | MEDICAID | 04132005 | 01 | IL | BCBS | OTHER |