Healthcare Provider Details

I. General information

NPI: 1225034796
Provider Name (Legal Business Name): VINCE VIOLA P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date: 06/14/2006
Reactivation Date: 01/31/2007

III. Provider practice location address

4351 RIDGEMONT DR STE A
ABILENE TX
79606-8747
US

IV. Provider business mailing address

4545 HARTFORD ST
ABILENE TX
79605-4602
US

V. Phone/Fax

Practice location:
  • Phone: 254-245-9175
  • Fax: 254-213-7771
Mailing address:
  • Phone: 325-698-4545
  • Fax: 325-698-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01177
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: