Provider Demographics
NPI:1477169076
Name:DOC'S INTERVENTIONAL SPORTS MEDICINE AND PRIMARY CARE P.L.L.C.
Entity Type:Organization
Organization Name:DOC'S INTERVENTIONAL SPORTS MEDICINE AND PRIMARY CARE P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MANDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-485-3226
Mailing Address - Street 1:3322 E WALNUT ST STE 112
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4305
Mailing Address - Country:US
Mailing Address - Phone:281-485-3226
Mailing Address - Fax:281-485-5520
Practice Address - Street 1:3322 E WALNUT ST STE 112
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4305
Practice Address - Country:US
Practice Address - Phone:281-485-3226
Practice Address - Fax:281-485-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1013352251OtherNPI