Provider Demographics
NPI:1629629050
Name:VANGUARD SPINE & SPORT, PLLC
Entity Type:Organization
Organization Name:VANGUARD SPINE & SPORT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGUESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-831-8656
Mailing Address - Street 1:8800 KATY FWY STE 105
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1645
Mailing Address - Country:US
Mailing Address - Phone:832-831-8656
Mailing Address - Fax:832-831-8674
Practice Address - Street 1:1533 N SHEPHERD DR STE 240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-3755
Practice Address - Country:US
Practice Address - Phone:832-831-8656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANGUARD SPINE & SPORT, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty