Provider Demographics
NPI:1417412461
Name:MEN'S VASCULAR PERFORMANCE CLINIC, LLC
Entity Type:Organization
Organization Name:MEN'S VASCULAR PERFORMANCE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-263-2690
Mailing Address - Street 1:PO BOX 330131
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-0131
Mailing Address - Country:US
Mailing Address - Phone:479-263-2690
Mailing Address - Fax:
Practice Address - Street 1:2431 SE WASHINGTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-7259
Practice Address - Country:US
Practice Address - Phone:479-263-2690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty