# PALESTINE VASCULAR LAB, LLC

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

## Provider details

- **NPI number:** 1346896982
- **Authorized official:** TONY ROTONDO (VP OF OPERATIONS)
- **Authorized official phone:** (713) 539-7477

## Contact information

- **Practice address:** 300 WILLOW CREEK PKWY STE 100, PALESTINE, TX 75801-4433
- **Practice address phone:** (903) 729-2888
- **Practice address fax:** (903) 729-2781
- **Mailing address:** 300 WILLOW CREEK PKWY STE 100, PALESTINE, TX 75801-4433
- **Mailing address phone:** (903) 729-2888
- **Mailing address fax:** (903) 729-2781

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/09/2019
- **Last updated:** 11/18/2019