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Organization
FORT WORTH VASCULAR AND SURGICAL ASSOCIATES, PA
Active
Organization
FORT WORTH VASCULAR AND SURGICAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA E PROVIDENZA (ADMINISTRATION)
(817) 614-9552
Entity
Organization
Contact information
Practice address
2737 S HULEN ST, FORT WORTH, TX 76109-9535
(817) 332-7544
(817) 338-9441
Mailing address
2737 S HULEN ST, FORT WORTH, TX 76109-9535
(817) 927-5627
(817) 927-7568
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
J6980
TX
Other
Enumeration date
11/17/2011
Last updated
11/08/2024
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