Provider Demographics
NPI:1205857927
Name:US VASCULAR ACCESS CENTER OF DALLAS, LLC
Entity Type:Organization
Organization Name:US VASCULAR ACCESS CENTER OF DALLAS, LLC
Other - Org Name:VASCULAR ACCESS CENTER OF DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P./G.M.
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-661-5766
Mailing Address - Street 1:3604 LIVE OAK ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6168
Mailing Address - Country:US
Mailing Address - Phone:214-826-4884
Mailing Address - Fax:214-826-6442
Practice Address - Street 1:3604 LIVE OAK ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6168
Practice Address - Country:US
Practice Address - Phone:214-826-4884
Practice Address - Fax:214-826-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007187261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1416422Medicaid
TX1416422Medicaid