Provider Demographics
NPI:1598779910
Name:QUANTITATIVE VASCULAR DIAGNOSTIC SERVICES, INC.
Entity Type:Organization
Organization Name:QUANTITATIVE VASCULAR DIAGNOSTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-754-1970
Mailing Address - Street 1:875 AUSTIN HINES DR
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-2874
Mailing Address - Country:US
Mailing Address - Phone:254-836-0861
Mailing Address - Fax:254-836-0479
Practice Address - Street 1:5010 LAKELAND CIR
Practice Address - Street 2:SUITE B
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2990
Practice Address - Country:US
Practice Address - Phone:254-754-1970
Practice Address - Fax:254-754-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTV004Medicare PIN