Provider Demographics
NPI:1891180485
Name:CENTRAL TEXAS VASCULAR ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:CENTRAL TEXAS VASCULAR ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WOODY
Authorized Official - Middle Name:J
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-666-2999
Mailing Address - Street 1:5940 CROSSLAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6986
Mailing Address - Country:US
Mailing Address - Phone:254-666-2999
Mailing Address - Fax:254-666-6000
Practice Address - Street 1:625 W CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1600
Practice Address - Country:US
Practice Address - Phone:254-953-0228
Practice Address - Fax:254-690-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty