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General NPI Number Information
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NPI Number | 1518191394
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Entity Type | Organization
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Legal Business Name | PRECISION VASCULAR, LLC
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 5255 JASON ST
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City | HOUSTON
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State | TX
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Zip | 77096-1320
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Country | US
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Telephone | 877-695-3448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20465
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City | HOUSTON
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State | TX
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Zip | 77225-0465
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Country | US
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Telephone | 877-695-3448
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. CORNELIUS DAVIS III
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Credential | M.D.
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Telephone | 877-695-3448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | L7349
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License Number State | TX
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