Provider Demographics
NPI:1114976560
Name:VIS PROCEDURE CENTER, PA
Entity Type:Organization
Organization Name:VIS PROCEDURE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:RAYNIOR
Authorized Official - Last Name:TURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-539-4031
Mailing Address - Street 1:2040 N LOOP 336 W
Mailing Address - Street 2:SUITE 314
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3500
Mailing Address - Country:US
Mailing Address - Phone:936-539-6497
Mailing Address - Fax:936-539-4612
Practice Address - Street 1:100 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2888
Practice Address - Country:US
Practice Address - Phone:936-539-4031
Practice Address - Fax:936-539-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0071NEOtherBLUE CROSS BLUE SHIELD TX
TX00W124Medicare PIN