Provider Demographics
NPI:1396768016
Name:DENTON VASCULAR LAB INC
Entity type:Organization
Organization Name:DENTON VASCULAR LAB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:940-566-6666
Mailing Address - Street 1:3322 COLORADO BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-6889
Mailing Address - Country:US
Mailing Address - Phone:940-566-6666
Mailing Address - Fax:940-387-3692
Practice Address - Street 1:3322 COLORADO BLVD STE 102
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6889
Practice Address - Country:US
Practice Address - Phone:940-566-6666
Practice Address - Fax:940-387-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022DCOtherBLUE CROSS OF TEXAS
TX088072602Medicaid
TX088142701Medicaid