# VASCULAR DIAGNOSTIC LABORATORY

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

## Provider details

- **NPI number:** 1598727331
- **Authorized official:** CHARLES HOLMES MCCOLLUM MD (CO DIRECTOR)
- **Authorized official phone:** (713) 798-8651

## Contact information

- **Practice address:** 6565 FANNIN, F922, HOUSTON, TX 77030-2707
- **Practice address phone:** (713) 978-8651
- **Practice address fax:** (713) 798-8252
- **Mailing address:** PO BOX 200100, HOUSTON, TX 77216-0100
- **Mailing address phone:** (713) 798-8651
- **Mailing address fax:** (713) 798-8252

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |
| 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