Provider Demographics
NPI:1912029331
Name:VEXOR MEDICALLY ADVANCED WELLNESS INC
Entity Type:Organization
Organization Name:VEXOR MEDICALLY ADVANCED WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CTO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MS, CCT
Authorized Official - Phone:713-467-6075
Mailing Address - Street 1:3102 MONA LEE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-3016
Mailing Address - Country:US
Mailing Address - Phone:281-710-7885
Mailing Address - Fax:832-565-1792
Practice Address - Street 1:3102 MONA LEE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-3016
Practice Address - Country:US
Practice Address - Phone:281-710-7885
Practice Address - Fax:832-565-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00064443246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty