NPIMap

Organization Active NPI

Palestine Vascular Lab, LLC

  • Medical Specialty Clinic/Center
  • Palestine, TX
National Provider Identifier
1346896982
Registry record updated Nov 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
PALESTINE VASCULAR LAB, LLC
Practice address
300 Willow Creek Pkwy Ste 100
Palestine, TX 75801-4433
Phone
(903) 729-2888
Fax
(903) 729-2781
NPI assigned
Aug 9, 2019
Last updated
Nov 18, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2019

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

Authorized official

Name
Tony Rotondo
Title
VP of Operations
Phone
(713) 539-7477

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Medical Specialty Clinic/Center 261QM2500X NU Primary

Addresses

Primary practice location

300 Willow Creek Pkwy Ste 100
Palestine, TX 75801-4433

Mailing address

300 Willow Creek Pkwy Ste 100
Palestine, TX 75801-4433
Phone (903) 729-2888

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1565308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574035200000",
    "number": "1346896982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WILLOW CREEK PKWY STE 100",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758014433",
            "telephone_number": "903-729-2888",
            "fax_number": "903-729-2781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WILLOW CREEK PKWY STE 100",
            "city": "PALESTINE",
            "state": "TX",
            "postal_code": "758014433",
            "telephone_number": "903-729-2888",
            "fax_number": "903-729-2781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALESTINE VASCULAR LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-09",
        "last_updated": "2019-11-18",
        "status": "A",
        "authorized_official_last_name": "ROTONDO",
        "authorized_official_first_name": "TONY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "713-539-7477"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palestine, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2019; 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.