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General NPI Number Information
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NPI Number | 1265085229
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Entity Type | Organization
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Legal Business Name | VASCULAR INSTITUTE OF NORTH TEXAS, PLLC
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 1305 AIRPORT FWY STE 103
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City | BEDFORD
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State | TX
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Zip | 76021-6603
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Country | US
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Telephone | 682-647-6500
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Fax | 469-320-1268
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Provider Business Mailing Address
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Address Line | 635 ANDERSON RD STE 4
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City | DAVIS
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State | CA
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Zip | 95616-3505
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Country | US
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Telephone | 682-647-6500
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Fax | 469-320-1268
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Authorized Official
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Title or Position | OWNER
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Name | TRACY L BASSO
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Credential |
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Telephone | 682-647-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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