Texas Varicose Vein Clinic of Fort Worth, LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

License

801678647 Issued in TX

Legal business name

TEXAS VARICOSE VEIN CLINIC OF FORT WORTH, LLC

Practice address

1106 Alston Ave
Ste 200
Fort Worth, TX 76104-4644

Phone

(817) 698-8346

Fax

(817) 698-9933

NPI assigned

Sep 2, 2014

Organization subpart

Yes

Parent organization

TEXAS VARICOSE VEIN CLINIC, LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Corey T Holtman

Title

Ceo

Phone

(817) 698-8346

Specialties & licenses 1

Addresses

Other names 1

• Gateway Vein & Leg Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409616000000",
    "number": "1003216649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1106 ALSTON AVE",
            "address_2": "STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044644",
            "telephone_number": "817-698-8346",
            "fax_number": "817-698-9933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1106 ALSTON AVE",
            "address_2": "STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761044644",
            "telephone_number": "817-698-8346",
            "fax_number": "817-698-9933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS VARICOSE VEIN CLINIC OF FORT WORTH, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TEXAS VARICOSE VEIN CLINIC, LLC",
        "enumeration_date": "2014-09-02",
        "last_updated": "2014-09-02",
        "status": "A",
        "authorized_official_last_name": "HOLTMAN",
        "authorized_official_first_name": "COREY",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "817-698-8346",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "TX",
            "license": "801678647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gateway Vein & Leg Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pain Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pain Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.