Healthcare Provider Details

I. General information

NPI: 1326524612
Provider Name (Legal Business Name): GREENHOUSE VASCULAR ACCESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 GREENHOUSE RD STE 1500
HOUSTON TX
77084-7855
US

IV. Provider business mailing address

3001 PALM HARBOR BLVD STE A
PALM HARBOR FL
34683-1930
US

V. Phone/Fax

Practice location:
  • Phone: 713-464-9100
  • Fax:
Mailing address:
  • Phone: 727-474-0090
  • Fax: 727-474-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: RAHUL PRAKASH
Title or Position: PRESIDENT
Credential: MD
Phone: 713-464-9100