MEDICARE: VANGUARD UROLOGIC ASSOCIATES, 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	174400000X	Specialist	J3225	TX

General Provider Information

NPI Number	:	1477763191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VANGUARD UROLOGIC ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	6400 FANNIN ST
Second Line	:	SUITE 2300
City	:	HOUSTON
State	:	TX
Zip	:	77030-1521
Country	:	US
Telephone Number	:	713-366-7848
Fax Number	:	713-366-7999

Provider Business Practice Location Address
First Line	:	6400 FANNIN ST STE 2300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1511
Country	:	US
Telephone Number	:	713-366-7848
Fax Number	:	713-366-7999

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. KEVIN M SLAWIN
Credential	:	MD
Telephone Number	:	713-366-7800

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	06/18/2008

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