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Organization
SOUTHWEST VASCULAR P.C.
Active
Organization
SOUTHWEST VASCULAR P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA PROVIDENZA (ADMISTRATOR)
(817) 614-9552
Entity
Organization
Contact information
Practice address
4300 CITY POINT DR STE 104, NORTH RICHLAND HILLS, TX 76180-8380
(817) 770-0608
(817) 616-3155
Mailing address
PO BOX 820604, NORTH RICHLAND HILLS, TX 76182-0604
(817) 770-0608
(817) 616-3155
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
NULL
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
03/12/2019
Last updated
07/09/2026
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