Healthcare Provider Details

I. General information

NPI: 1275062572
Provider Name (Legal Business Name): VMA PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 8TH AVE
FORT WORTH TX
76104-4137
US

IV. Provider business mailing address

PO BOX 470667
FORT WORTH TX
76147-0667
US

V. Phone/Fax

Practice location:
  • Phone: 713-203-8453
  • Fax: 877-443-0992
Mailing address:
  • Phone: 713-203-8453
  • Fax: 877-443-0992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD DANIEL MAYABB
Title or Position: PRESIDENT
Credential:
Phone: 713-203-8453