MEDICARE: VEIN CENTER FOR EXCELLENCE OF DALLAS

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

General Provider Information

NPI Number	:	1790734457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEIN CENTER FOR EXCELLENCE OF DALLAS

Provider Business Mailing Address
First Line	:	4222 TRINITY MILLS RD
Second Line	:	SUITE 212
City	:	DALLAS
State	:	TX
Zip	:	75287-7603
Country	:	US
Telephone Number	:	972-267-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4222 TRINITY MILLS RD
Second Line	:	SUITE 212
City	:	DALLAS
State	:	TX
Zip	:	75287-7603
Country	:	US
Telephone Number	:	972-267-4600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HENRY T HORRILLENO
Credential	:	MD
Telephone Number	:	972-267-4600

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/22/2020

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