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General NPI Number Information
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NPI Number | 1275062572
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Entity Type | Organization
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Legal Business Name | VMA PARTNERS LLC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 1307 8TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-4137
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Country | US
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Telephone | 713-203-8453
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Fax | 877-443-0992
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Provider Business Mailing Address
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Address Line | PO BOX 470667
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City | FORT WORTH
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State | TX
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Zip | 76147-0667
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Country | US
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Telephone | 713-203-8453
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Fax | 877-443-0992
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD DANIEL MAYABB
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Credential |
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Telephone | 713-203-8453
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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