Healthcare Provider Details

I. General information

NPI: 1982955175
Provider Name (Legal Business Name): BRAZOS VASCULAR ACCESS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 BRIARCREST DR STE 100B
BRYAN TX
77802-2737
US

IV. Provider business mailing address

PO BOX 29364
SAN ANTONIO TX
78229-0364
US

V. Phone/Fax

Practice location:
  • Phone: 210-616-9990
  • Fax: 210-298-9416
Mailing address:
  • Phone: 210-616-9990
  • Fax: 210-298-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EMMANUEL ANEKWE
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 210-616-9990