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General NPI Number Information
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NPI Number | 1932459476
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Entity Type | Organization
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Legal Business Name | VASCULAR AND INTERVENTIONAL RADIOLOGY OF AMERICA
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 1213 HERMANN DR SUITE 255
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City | HOUSTON
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State | TX
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Zip | 77004-7018
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Country | US
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Telephone | 713-955-1707
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Fax | 713-955-1699
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Provider Business Mailing Address
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Address Line | 1213 HERMANN DR STE 255
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City | HOUSTON
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State | TX
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Zip | 77004-7074
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Country | US
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Telephone | 713-955-1707
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Fax | 713-955-1699
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | JENNIFER WEN DOE
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Credential |
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Telephone | 315-323-0236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology 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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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