Endovascular Lab PLLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

ENDOVASCULAR LAB PLLC

Practice address

612 N Washington Avenue
Suite 100
Odessa, TX 79761

Phone

(432) 770-7211

NPI assigned

Mar 16, 2020

Organization subpart

No

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

Authorized official

Name

Dr. James Y Li, MDNPI 1932184629

Title

President

Phone

(432) 770-7211

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Y Li, MD

  • Vascular Surgery Physician
  • Odessa, TX
  • NPI 1932184629
  Medicare reassignment Care Compare group NPD Authorized official
• Daniela Maria Flores, DNP, FNP-C

  • Nurse Practitioner
  • Odessa, TX
  • NPI 1255044947
  Medicare reassignment Care Compare group NPD
• Kelly Rene Mattimoe, FNP

  • Family Nurse Practitioner
  • Odessa, TX
  • NPI 1235867623
  Medicare reassignment NPD

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1407482003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 N WASHINGTON AVENUE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "79761",
            "telephone_number": "432-770-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 N WASHINGTON AVENUE",
            "address_2": "SUITE 100",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "79761",
            "telephone_number": "432-770-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDOVASCULAR LAB PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-16",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "432-770-7211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Halie Elzoghbi, M.S.
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• Emh Dental Associates PLLC
• Joud Enabi
• Christopher Atsaboghena Enakpene, MD
• Sridhar Enuganti, M.D.
• Ashritha Enukonda
• Emmanuel Enverga, PT, DPT
• Chibuike Leonard Enwereuzo, M.D.
• Eot-Ads LP

• Vascular Surgery Physician in Odessa, TX
• Providers in Odessa, TX by specialty
• Vascular Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; 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.