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General NPI Number Information
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NPI Number | 1275003311
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL AND VASCULAR CARE INC
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Dates
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Enumeration Date | 12/02/2018
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Last Update Date | 12/02/2018
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Provider Practice Location Address
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Address Line | 12840 HILLCREST RD STE E104
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City | DALLAS
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State | TX
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Zip | 75230-1528
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Country | US
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Telephone | 214-341-8770
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 92670
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City | SOUTHLAKE
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State | TX
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Zip | 76092-0670
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | LAWRENCE RANDALL MARTIN
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Credential | CPA
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Telephone | 817-988-0986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0205X
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Taxonomy Name | Radiological Physics Physician
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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 | 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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