Provider Demographics
NPI:1144595703
Name:VIDASURE LLC
Entity Type:Organization
Organization Name:VIDASURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:214-253-9397
Mailing Address - Street 1:3245 W MAIN ST
Mailing Address - Street 2:STE 235-142
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3245 W MAIN ST
Practice Address - Street 2:STE 235-142
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4411
Practice Address - Country:US
Practice Address - Phone:214-253-9397
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management