Provider Demographics
NPI:1982095329
Name:VASCULAR CARE OF TEXAS, PLLC
Entity Type:Organization
Organization Name:VASCULAR CARE OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDIC
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-426-9900
Mailing Address - Street 1:601 CLARA BARTON BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5747
Mailing Address - Country:US
Mailing Address - Phone:972-426-9900
Mailing Address - Fax:972-426-9899
Practice Address - Street 1:601 CLARA BARTON BLVD STE 350
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5747
Practice Address - Country:US
Practice Address - Phone:972-426-9900
Practice Address - Fax:972-426-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348242401Medicaid