Provider Demographics
NPI:1932459476
Name:VASCULAR AND INTERVENTIONAL RADIOLOGY OF AMERICA
Entity Type:Organization
Organization Name:VASCULAR AND INTERVENTIONAL RADIOLOGY OF AMERICA
Other - Org Name:ALATE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:WEN
Authorized Official - Last Name:DOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-323-0236
Mailing Address - Street 1:1213 HERMANN DR STE 255
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7074
Mailing Address - Country:US
Mailing Address - Phone:713-955-1707
Mailing Address - Fax:713-955-1699
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:SUITE 255
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-955-1707
Practice Address - Fax:713-955-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342319601Medicaid