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General NPI Number Information
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NPI Number | 1679981492
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Entity Type | Organization
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Legal Business Name | NORTH TEXAS VASCULAR CENTER PA
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Dates
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Enumeration Date | 07/24/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 3865 CHILDRESS AVE SUITE C
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City | MESQUITE
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State | TX
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Zip | 75150-2802
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Country | US
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Telephone | 972-885-8346
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Fax | 214-466-1976
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Provider Business Mailing Address
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Address Line | 3865 CHILDRESS AVE SUITE C
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City | MESQUITE
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State | TX
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Zip | 75150-2802
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Country | US
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Telephone | 972-885-8346
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Fax | 214-466-1976
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MISS DAWN MORGAN
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Credential |
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Telephone | 941-953-7451
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | J1900
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | J1900
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License Number State | TX
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