Provider Demographics
NPI:1912142084
Name:ULTRA HYDRO VASCULAR SYSTEMS LLC
Entity Type:Organization
Organization Name:ULTRA HYDRO VASCULAR SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, FSVM
Authorized Official - Phone:254-230-8296
Mailing Address - Street 1:875 AUSTIN HINES DR
Mailing Address - Street 2:
Mailing Address - City:CHINA SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:76633-2874
Mailing Address - Country:US
Mailing Address - Phone:254-230-8296
Mailing Address - Fax:254-754-4494
Practice Address - Street 1:5010 LAKELAND CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2981
Practice Address - Country:US
Practice Address - Phone:254-230-8296
Practice Address - Fax:254-754-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility