Broadway Vascular PLLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

BROADWAY VASCULAR PLLC

Practice address

1010 NW Loop 410 Ste 100-B
San Antonio, TX 78213-2220

Phone

(210) 465-7015

Fax

(210) 465-7014

NPI assigned

Jul 1, 2021

Last updated

Aug 11, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dallas L Broadway, MDNPI 1366646416

Title

Medical Director

Phone

(210) 465-7015

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Dallas Broadway, M.D.

  • Diagnostic Radiology Physician
  • New York, NY
  • NPI 1366646416
  Authorized official Same address or phone

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

{
    "created_epoch": "1625097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1588235436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 NW LOOP 410 STE 100-B",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782132220",
            "telephone_number": "210-465-7015",
            "fax_number": "210-465-7014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 NW LOOP 410 STE 100-B",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782132220",
            "telephone_number": "210-465-7015",
            "fax_number": "210-465-7014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY VASCULAR PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-01",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "BROADWAY",
        "authorized_official_first_name": "DALLAS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "210-465-7015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Myranda Broadwater
• Broadway Chiropractic Clinic, PC
• Broadway Convalescent Center, L.P. (Stonebrook Manor at Broadway)
• Broadway Healthcare LLC (Broadway Rehabilitation and Care Center)
• Broadway Pediatric Dentistry, PLLC
• Demonica Ann Broadway, LMSW
• Jeremy Brock, RRT, RCP
• Joi Raye Brock, LM, CPM, LMT
• Kaleece E Brock
• Kan'Dace Len Brock, LMSW

• Vascular & Interventional Radiology Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Vascular & Interventional Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.