NPIMap

Organization Active NPI

Center for Vein Restoration TX2 LLC

  • Surgery Physician
  • Fort Worth, TX
National Provider Identifier
1295625754
Registry record updated Sep 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
CENTER FOR VEIN RESTORATION TX2 LLC
Practice address
5668 Edwards Ranch Rd Ste 200
Fort Worth, TX 76109-4110
Phone
(855) 830-8346
Fax
(240) 473-4321
NPI assigned
Jul 7, 2025
Last updated
Sep 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2025

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

Authorized official

Name
Khanh Q Nguyen, DONPI 1780627976
Title
Chief Medical Officer
Phone
(855) 830-8346

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

5668 Edwards Ranch Rd Ste 200
Fort Worth, TX 76109-4110

Mailing address

7474 Greenway Center Dr Ste 1000
Greenbelt, MD 20770-3500
Phone (855) 830-8346

Other practice location 1

1600 Lancaster Dr Ste 103
Grapevine, TX 76051-3579
Phone (855) 830-8346

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250831000092 TX Part B Supplier - Clinic/Group Practice 2668973678 Receives reassigned benefits from 5 practitioners
Practice locations: Fort Worth, TX; Grapevine, TX; Irving, TX

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Center for Vein Restoration TX2 LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

129 Vision Park Blvd
Ste 207
Shenandoah, TX 77384

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1751846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758672000000",
    "number": "1295625754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7474 GREENWAY CENTER DR STE 1000",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207703500",
            "telephone_number": "855-830-8346",
            "fax_number": "240-473-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5668 EDWARDS RANCH RD STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094110",
            "telephone_number": "855-830-8346",
            "fax_number": "240-473-4321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 Lancaster Dr Ste 103",
            "address_purpose": "LOCATION",
            "city": "Grapevine",
            "state": "TX",
            "postal_code": "760513579",
            "country_code": "US",
            "telephone_number": "855-830-8346",
            "fax_number": "240-473-4321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CENTER FOR VEIN RESTORATION TX2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-07",
        "last_updated": "2025-09-24",
        "certification_date": "2025-09-24",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KHANH",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "855-830-8346",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.