Healthcare Provider Details

I. General information

NPI: 1497123616
Provider Name (Legal Business Name): PREMIER VASCULAR CENTER OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/21/2023
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 HARROUN AVE 200
MCKINNEY TX
75069
US

IV. Provider business mailing address

2871 LAKE VISTA DR SUITE 210
LEWISVILLE TX
75067
US

V. Phone/Fax

Practice location:
  • Phone: 940-442-5209
  • Fax: 940-222-2720
Mailing address:
  • Phone: 940-442-5209
  • Fax: 940-222-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL LEIN NGUYEN
Title or Position: COO
Credential:
Phone: 940-442-5209