=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134308091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH TEXAS VEIN PARTNERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/29/2007
-----------------------------------------------------
Last Update Date | 01/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2737 S HULEN ST
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76109-9535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-927-5627
-----------------------------------------------------
Fax | 817-927-7568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2737 S HULEN ST
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76109-9535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-927-5627
-----------------------------------------------------
Fax | 817-927-7568
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ONWER
-----------------------------------------------------
Name | JOSEPH E GUINN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 817-927-5627
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 65842
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | K3785
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------