MEDICARE: VANGUARD DIAGNOSTIC, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QP2000X	Physical Therapy Clinic/Center
2	261QR0200X	Radiology Clinic/Center
3	261QR0400X	Rehabilitation Clinic/Center
4	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1619502226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANGUARD DIAGNOSTIC, LLC

Provider Business Mailing Address
First Line	:	4303 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-5597
Country	:	US
Telephone Number	:	214-534-9325
Fax Number	:

Provider Business Practice Location Address
First Line	:	4303 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75205-5597
Country	:	US
Telephone Number	:	214-534-9325
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CARL WEINKAUF
Credential	:
Telephone Number	:	214-534-9325

Provider Enumeration Date	:	03/04/2020
Last Update Date	:	03/26/2020

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Directions to “VANGUARD DIAGNOSTIC, LLC ” Practice Location

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