# FORT WORTH VASCULAR AND SURGICAL ASSOCIATES, PA

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

## Provider details

- **NPI number:** 1851668925
- **Authorized official:** MARTHA E PROVIDENZA (ADMINISTRATION)
- **Authorized official phone:** (817) 614-9552

## Contact information

- **Practice address:** 2737 S HULEN ST, FORT WORTH, TX 76109-9535
- **Practice address phone:** (817) 332-7544
- **Practice address fax:** (817) 338-9441
- **Mailing address:** 2737 S HULEN ST, FORT WORTH, TX 76109-9535
- **Mailing address phone:** (817) 927-5627
- **Mailing address fax:** (817) 927-7568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | J6980 | TX | Yes |

## Other

- **Enumeration date:** 11/17/2011
- **Last updated:** 11/08/2024