Provider Demographics
NPI:1366868903
Name:DIAGNOSTIC, INTERVENTIONAL AND VASCULAR CONSULTANTS LLC
Entity Type:Organization
Organization Name:DIAGNOSTIC, INTERVENTIONAL AND VASCULAR CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR BUSINESS OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LANISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-795-1152
Mailing Address - Street 1:PO BOX 301103
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77230-1103
Mailing Address - Country:US
Mailing Address - Phone:713-790-1666
Mailing Address - Fax:713-383-4470
Practice Address - Street 1:8305 KNIGHT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-3905
Practice Address - Country:US
Practice Address - Phone:713-790-1666
Practice Address - Fax:713-383-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty