MEDICARE: PROFESSIONAL VASCULAR DIAGNOSTICS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1023258894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL VASCULAR DIAGNOSTICS INC.

Provider Business Mailing Address
First Line	:	PO BOX 740213
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75374-0213
Country	:	US
Telephone Number	:	214-577-7012
Fax Number	:	469-728-0838

Provider Business Practice Location Address
First Line	:	8210 WALNUT HILL LN
Second Line	:	SUITE 907
City	:	DALLAS
State	:	TX
Zip	:	75231-4405
Country	:	US
Telephone Number	:	214-577-7012
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. JON CHRISTOPHER KENDALL
Credential	:	RVT
Telephone Number	:	214-577-7012

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	03/05/2009

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