# INNOVATIVE VASCULAR INSTITUTE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134803869
- **Authorized official:** DR. WILLIAM D LONG MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (318) 792-6589

## Contact information

- **Practice address:** 1010 NW LOOP 410 STE 100B, SAN ANTONIO, TX 78213-2220
- **Practice address phone:** (210) 465-7015
- **Practice address fax:** (210) 465-7014
- **Mailing address:** 1010 NW LOOP 410 STE 100B, SAN ANTONIO, TX 78213-2220
- **Mailing address phone:** (210) 465-7015
- **Mailing address fax:** (210) 465-7014

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | Yes |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/13/2023
- **Last updated:** 06/13/2023