Healthcare Provider Details

I. General information

NPI: 1417360280
Provider Name (Legal Business Name): TEXAN VEIN & VASCULAR, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 E. WHITESTONE BLVD SUITE 300
CEDAR PARK TX
78613-6934
US

IV. Provider business mailing address

1785 E. WHITESTONE BLVD SUITE 300
CEDAR PARK TX
78613-6934
US

V. Phone/Fax

Practice location:
  • Phone: 512-387-0114
  • Fax: 512-454-5252
Mailing address:
  • Phone: 512-387-0114
  • Fax: 512-454-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberQ0378
License Number StateTX

VIII. Authorized Official

Name: VINIT N VARU
Title or Position: OWNER, MANAGING PHYSICIAN
Credential: M.D.
Phone: 512-692-4915