Basic Information
| Provider Information | |||||||||
| NPI: | 1316388770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GARLAND VASCULAR PARTNERS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 674038 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752674038 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 CLARA BARTON BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750425738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722344740 | ||||||||
| FaxNumber: | 9722317095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2013 | ||||||||
| LastUpdateDate: | 07/15/2013 | ||||||||
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| AuthorizedOfficialLastName: | WALLS | ||||||||
| AuthorizedOfficialFirstName: | TRACY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9722344740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.