Provider Demographics
NPI:1790734457
Name:VEIN CENTER FOR EXCELLENCE OF DALLAS
Entity Type:Organization
Organization Name:VEIN CENTER FOR EXCELLENCE OF DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HORRILLENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-267-4600
Mailing Address - Street 1:4222 TRINITY MILLS RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7603
Mailing Address - Country:US
Mailing Address - Phone:972-267-4600
Mailing Address - Fax:
Practice Address - Street 1:4222 TRINITY MILLS RD
Practice Address - Street 2:SUITE 212
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7603
Practice Address - Country:US
Practice Address - Phone:972-267-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00017ZMedicare UPIN