# VASCULAR DIAGNOSTIC LAB

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

## Provider details

- **NPI number:** 1245454073
- **Authorized official:** MRS. RITA POLSKY (ADMINISTRATOR)
- **Authorized official phone:** (575) 635-7145

## Contact information

- **Practice address:** 3850 FOOTHILLS RD., \#3, LAS CRUCES, NM 88011-8268
- **Practice address phone:** (575) 522-5511
- **Practice address fax:** (575) 522-0825
- **Mailing address:** P.O. BOX 6366, LAS CRUCES, NM 88006-6366
- **Mailing address phone:** (575) 522-5511
- **Mailing address fax:** (575) 522-0825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 293D00000X | Physiological Laboratory | — | — | Yes |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 12/31/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00052597 | — | NM |