Provider Demographics
NPI:1578223673
Name:VAIL PHYSICIAN SERVICES, PLLC
Entity Type:Organization
Organization Name:VAIL PHYSICIAN SERVICES, PLLC
Other - Org Name:VAIL PHYSICIAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:972-476-1848
Mailing Address - Street 1:3004 COMMUNICATIONS PKWY STE 200-292
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8909
Mailing Address - Country:US
Mailing Address - Phone:972-476-1848
Mailing Address - Fax:
Practice Address - Street 1:960 RIDGEVIEW DR STE 140-292
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5542
Practice Address - Country:US
Practice Address - Phone:972-476-1848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty