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Organization
VASCULAR DIAGNOSTIC LABORATORY
Active
Organization
VASCULAR DIAGNOSTIC LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES HOLMES MCCOLLUM MD (CO DIRECTOR)
(713) 798-8651
Entity
Organization
Contact information
Practice address
6565 FANNIN, F922, HOUSTON, TX 77030-2707
(713) 978-8651
(713) 798-8252
Mailing address
PO BOX 200100, HOUSTON, TX 77216-0100
(713) 798-8651
(713) 798-8252
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
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
Other
Enumeration date
04/05/2006
Last updated
12/21/2007
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