Provider Demographics
NPI:1245643980
Name:WOODLANDS VASCULAR ACCESS CENTER LLC
Entity type:Organization
Organization Name:WOODLANDS VASCULAR ACCESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-271-3400
Mailing Address - Street 1:17191 ST LUKES WAY STE 280
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8043
Mailing Address - Country:US
Mailing Address - Phone:936-202-1260
Mailing Address - Fax:913-904-3422
Practice Address - Street 1:17191 ST LUKES WAY STE 280
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-8043
Practice Address - Country:US
Practice Address - Phone:832-928-6993
Practice Address - Fax:913-904-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty