Provider Demographics
NPI:1235542390
Name:AVICENNA VASCULAR INSTITUTE LLC
Entity Type:Organization
Organization Name:AVICENNA VASCULAR INSTITUTE LLC
Other - Org Name:AVICENNA VASCULAR INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-208-3518
Mailing Address - Street 1:4201 MEDICAL CENTER DR
Mailing Address - Street 2:STE 220
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1766
Mailing Address - Country:US
Mailing Address - Phone:972-529-6939
Mailing Address - Fax:972-529-6935
Practice Address - Street 1:4201 MEDICAL CENTER DR STE 220
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1768
Practice Address - Country:US
Practice Address - Phone:214-544-6050
Practice Address - Fax:214-544-6049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356334031Medicare PIN