MEDICARE: WILLOWBEND VASCULAR SERVICES LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1427542869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOWBEND VASCULAR SERVICES LLC

Provider Business Mailing Address
First Line	:	2633 DALLAS PKWY STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2633 DALLAS PKWY STE 100
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4715
Country	:	US
Telephone Number	:	972-947-2447
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	RISHIN SHAH
Credential	:	MD
Telephone Number	:	314-973-0633

Provider Enumeration Date	:	06/19/2018
Last Update Date	:	06/19/2018

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