MEDICARE: US VASCULAR ACCESS CENTER OF DALLAS, LLC

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	261QR0200X	Radiology Clinic/Center	007187	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205857927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US VASCULAR ACCESS CENTER OF DALLAS, LLC

Provider Business Mailing Address
First Line	:	3604 LIVE OAK ST
Second Line	:	SUITE 300
City	:	DALLAS
State	:	TX
Zip	:	75204-6168
Country	:	US
Telephone Number	:	214-826-4884
Fax Number	:	214-826-6442

Provider Business Practice Location Address
First Line	:	3604 LIVE OAK ST
Second Line	:	SUITE 300
City	:	DALLAS
State	:	TX
Zip	:	75204-6168
Country	:	US
Telephone Number	:	214-826-4884
Fax Number	:	214-826-6442

Authorized Official
Title or Position	:	V.P./G.M.
Name	:	MR. MICHAEL PERRY
Credential	:
Telephone Number	:	407-661-5766

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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Directions to “US VASCULAR ACCESS CENTER OF DALLAS, LLC ” Practice Location

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