Provider Demographics
NPI:1922572809
Name:ENDOVASCULAR CONSULTING SOLUTIONS
Entity Type:Organization
Organization Name:ENDOVASCULAR CONSULTING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COMSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-744-9400
Mailing Address - Street 1:1705 E 19TH ST STE 410
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5415
Mailing Address - Country:US
Mailing Address - Phone:918-744-9400
Mailing Address - Fax:918-744-9416
Practice Address - Street 1:1705 E 19TH ST STE 410
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5415
Practice Address - Country:US
Practice Address - Phone:918-744-9400
Practice Address - Fax:918-744-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty