Provider Demographics
NPI:1164751830
Name:MARK VANN MD PLLC
Entity Type:Organization
Organization Name:MARK VANN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VANN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:202-746-9044
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-0002
Mailing Address - Country:US
Mailing Address - Phone:713-876-6518
Mailing Address - Fax:832-623-6236
Practice Address - Street 1:7789 SOUTHWEST FWY
Practice Address - Street 2:SUITE 410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1834
Practice Address - Country:US
Practice Address - Phone:713-876-6518
Practice Address - Fax:832-623-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9069207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217607501Medicaid
1164751830OtherNPI
TX0A5911Medicare PIN
1164751830OtherNPI
TX6604550001Medicare NSC