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General NPI Number Information
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NPI Number | 1134803869
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Entity Type | Organization
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Legal Business Name | INNOVATIVE VASCULAR INSTITUTE, PLLC
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Dates
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Enumeration Date | 06/13/2023
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 1010 NW LOOP 410 STE 100B
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2220
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Country | US
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Telephone | 210-465-7015
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Fax | 210-465-7014
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Provider Business Mailing Address
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Address Line | 1010 NW LOOP 410 STE 100B
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2220
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Country | US
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Telephone | 210-465-7015
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Fax | 210-465-7014
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. WILLIAM D LONG
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Credential | MD
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Telephone | 318-792-6589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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