Provider Demographics
NPI:1689235889
Name:VIGILANT HEALTHCARE SOLUTIONS PLLC
Entity Type:Organization
Organization Name:VIGILANT HEALTHCARE SOLUTIONS PLLC
Other - Org Name:VIGILANT HEALTHCARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAZZARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-316-5498
Mailing Address - Street 1:2911 TURTLE CREEK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-6243
Mailing Address - Country:US
Mailing Address - Phone:888-316-5498
Mailing Address - Fax:888-316-5498
Practice Address - Street 1:2911 TURTLE CREEK BLVD STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-6243
Practice Address - Country:US
Practice Address - Phone:888-316-5498
Practice Address - Fax:888-316-5498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI127039910Medicaid