Healthcare Provider Details

I. General information

NPI: 1760343719
Provider Name (Legal Business Name): CENTER FOR VEIN RESTORATION TX2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5668 EDWARDS RANCH RD STE 200
FORT WORTH TX
76109-4110
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 1000
GREENBELT MD
20770-3500
US

V. Phone/Fax

Practice location:
  • Phone: 855-830-8346
  • Fax:
Mailing address:
  • Phone: 240-965-3261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: LORENA THOMAS
Title or Position: CRED MANAGER
Credential:
Phone: 815-254-1761