Healthcare Provider Details

I. General information

NPI: 1497094841
Provider Name (Legal Business Name): VANGUARD MEDREVIEW INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 PARKCHESTER DR
ARLINGTON TX
76015-1015
US

IV. Provider business mailing address

2732 PARKCHESTER DR
ARLINGTON TX
76015-1015
US

V. Phone/Fax

Practice location:
  • Phone: 817-602-1478
  • Fax: 817-632-2619
Mailing address:
  • Phone: 817-602-1478
  • Fax: 817-632-2619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: HEATHER JENNETT
Title or Position: PRESIDENT
Credential:
Phone: 817-602-1478