Healthcare Provider Details

I. General information

NPI: 1801339742
Provider Name (Legal Business Name): VANGUARD INPATIENT PHYSICIAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2016
Last Update Date: 06/14/2023
Certification Date: 06/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4645 SWEETWATER BLVD STE 200
SUGAR LAND TX
77479-3016
US

IV. Provider business mailing address

4645 SWEETWATER BLVD STE 200
SUGAR LAND TX
77479-3016
US

V. Phone/Fax

Practice location:
  • Phone: 281-666-8065
  • Fax: 281-666-8475
Mailing address:
  • Phone: 281-666-8065
  • Fax: 281-666-8475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ARUSHA BAVARE
Title or Position: OFFICER
Credential:
Phone: 281-666-8065