Provider Demographics
NPI:1285961201
Name:ACCURATE VASCULAR DIAGNOSTIC CENTER, LLC
Entity type:Organization
Organization Name:ACCURATE VASCULAR DIAGNOSTIC CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALLY
Authorized Official - Middle Name:REYNALDO
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:956-994-9193
Mailing Address - Street 1:2000 S MCCOLL RD
Mailing Address - Street 2:SUITE B, PMB 163
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1501
Mailing Address - Country:US
Mailing Address - Phone:956-994-9193
Mailing Address - Fax:
Practice Address - Street 1:1801 S 5TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2927
Practice Address - Country:US
Practice Address - Phone:956-994-9193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTV017Medicare UPIN