Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Modern Vascular of Southaven, LLC

Organization Vascular & Interventional Radiology Physician · NPI 1174171441

Modern Vascular of Southaven, LLC is a Vascular & Interventional Radiology Physician in Southaven, Mississippi. Registered with an NPI since 2019.

In the registry since
2019
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

55 Physicians Ln
Southaven, MS 38671-9569
Phone: (662) 655-2136
Fax: (662) 996-2214
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Vascular & Interventional Radiology Physician (primary) Taxonomy 2085R0204X
Vascular-Interventional Technology Radiologic Technologist Taxonomy 2471V0106X

Record details

NPI number1174171441
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Yury Gampel — Manager · (818) 880-8605
NPI enumeratedAugust 29, 2019
Last updated in NPPESAugust 29, 2019
Mailing address26500 Agoura Rd Ste 201, Calabasas, CA 91302-3556

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