# PERIPHERAL VASCULAR ASSOCIATES, P.A.

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

## Provider details

- **NPI number:** 1396791570
- **Authorized official:** MS. PHYLLIS B. DAVENPORT (ADMINISTRATOR)
- **Authorized official phone:** (210) 237-4492

## Contact information

- **Practice address:** 610 NORTH MAIN AVENUE, 2ND FLOOR, SAN ANTONIO, TX 78205-1204
- **Practice address phone:** (210) 237-4492
- **Practice address fax:** (210) 828-0590
- **Mailing address:** 610 NORTH MAIN, SECOND FLOOR, SAN ANTONIO, TX 78205-1204
- **Mailing address phone:** (210) 237-4492
- **Mailing address fax:** (210) 828-0590

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RI0011X | Interventional Cardiology Physician | — | NULL | — |
| 207RI0011X | Interventional Cardiology Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |
| 224P00000X | Prosthetist | — | NULL | — |
| 224P00000X | Prosthetist | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LA2100X | Acute Care Nurse Practitioner | — | NULL | — |
| 363LA2100X | Acute Care Nurse Practitioner | — | — | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | — |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/26/2006
- **Last updated:** 07/21/2023