MEDICARE: TEXAN VEIN & VASCULAR, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	Q0378	TX

General Provider Information

NPI Number	:	1417360280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAN VEIN & VASCULAR, PLLC

Provider Business Mailing Address
First Line	:	1785 E. WHITESTONE BLVD
Second Line	:	SUITE 300
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-6934
Country	:	US
Telephone Number	:	512-387-0114
Fax Number	:	512-454-5252

Provider Business Practice Location Address
First Line	:	1785 E. WHITESTONE BLVD
Second Line	:	SUITE 300
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-6934
Country	:	US
Telephone Number	:	512-387-0114
Fax Number	:	512-454-5252

Authorized Official
Title or Position	:	OWNER, MANAGING PHYSICIAN
Name	:	VINIT N VARU
Credential	:	M.D.
Telephone Number	:	512-692-4915

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	10/17/2014

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