MEDICARE: INSTITUTE FOR VASCULAR TESTING

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	2471V0106X	Vascular-Interventional Technology Radiologic Technologist

General Provider Information

NPI Number	:	1952658742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR VASCULAR TESTING

Provider Business Mailing Address
First Line	:	2255 S BASCOM AVE STE 205
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-7800
Country	:	US
Telephone Number	:	408-376-3626
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 S BASCOM AVE STE 205
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-7800
Country	:	US
Telephone Number	:	408-376-3626
Fax Number	:

Authorized Official
Title or Position	:	TECHNICAL DIRECTOR
Name	:	DEBBIE HOOVER
Credential	:
Telephone Number	:	408-376-3626

Provider Enumeration Date	:	08/10/2012
Last Update Date	:	08/10/2012

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