Healthcare Provider Details

I. General information

NPI: 1962941146
Provider Name (Legal Business Name): NORTH TEXAS VMA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 COIT RD SUITE 405
FRISCO TX
75035-0521
US

IV. Provider business mailing address

4461 COIT RD SUITE 405
FRISCO TX
75035-0521
US

V. Phone/Fax

Practice location:
  • Phone: 832-667-8132
  • Fax: 281-664-5899
Mailing address:
  • Phone: 832-667-8132
  • Fax: 281-664-5899

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: MRS. SIAN R NAVA
Title or Position: BILLING DIRECTOR
Credential:
Phone: 832-667-8132