The Vein Clinic of Dallas LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

THE VEIN CLINIC OF DALLAS LLC

Practice address

3051 Churchill Dr Ste 116
Flower Mound, TX 75022-5900

Phone

(698) 468-3464

Fax

(469) 409-0001

NPI assigned

Apr 6, 2020

Organization subpart

No

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

Authorized official

Name

Husein Poonawala, MNPI 1275823890

Title

Managing Director

Phone

(818) 825-3038

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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.

• Husein Imtiaz Poonawala, M.D.

  • Vascular & Interventional Radiology Physician
  • Flower Mound, TX
  • NPI 1275823890
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646611200000",
    "number": "1760011308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3051 CHURCHILL DR STE 116",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750225900",
            "telephone_number": "469-846-8346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3051 CHURCHILL DR STE 116",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750225900",
            "telephone_number": "698-468-3464",
            "fax_number": "469-409-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VEIN CLINIC OF DALLAS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-06",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A",
        "authorized_official_last_name": "POONAWALA",
        "authorized_official_first_name": "HUSEIN",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "818-825-3038",
        "authorized_official_credential": "M"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vascular & Interventional Radiology Physician in Flower Mound, TX
• Providers in Flower Mound, 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 Mar 7, 2022; 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.