Provider Demographics
NPI:1699925818
Name:INTERVENTIONAL VASCULAR CENTER LLC
Entity type:Organization
Organization Name:INTERVENTIONAL VASCULAR CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:P
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-909-8316
Mailing Address - Street 1:6906 SIR LANCELOT
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-5301
Mailing Address - Country:US
Mailing Address - Phone:512-909-8316
Mailing Address - Fax:361-334-3926
Practice Address - Street 1:5602 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-6325
Practice Address - Country:US
Practice Address - Phone:210-299-4440
Practice Address - Fax:210-299-4442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty