TEXAS VARICOSE VEIN CLINIC OF FORT WORTH, LLC (NPI# 1003216649) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003216649 |
| Entity Type | Organization |
| Organization Name | TEXAS VARICOSE VEIN CLINIC OF FORT WORTH, LLC |
| Other Organization Name | GATEWAY VEIN & LEG CENTER |
| Practice Address |
1106 Alston Ave Ste 200 Fort Worth TX 76104-4644 |
| Practice Telephone | 8176988346 |
| Practice Fax Number | 8176989933 |
| Mailing Telephone | 8176988346 |
| Mailing Fax Number | 8176989933 |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2014-09-02 |
| Authorized Official Name | MR. COREY T HOLTMAN (CEO) |
| Authorized Official Telephone | 8176988346 |
| Is Organization Subpart | Y |
| Parent Organization Name | TEXAS VARICOSE VEIN CLINIC, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP3300X |
Clinic/Center Specialization: Pain |
801678647 | TX | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Gateway Vein & Leg Center | Doing Business As Name - Organization |
| Street Address |
1106 ALSTON AVE STE 200 |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76104-4644 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598000689 | Ashli Doss | Dietitian, Registered | 1106 Alston Ave, Suite 201, Fort Worth, TX 76104-4644 | 2012-11-30 |
| 1649510991 | Cardiac Cath Lab of Fort Worth Lp | Clinic/Center | 1106 Alston Ave, Suite 100, Fort Worth, TX 76104-4644 | 2013-02-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669082186 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 1115 8th St, Fort Worth, TX 76104 | 2020-08-10 |
| 1992343693 | Iris Giove | Psychologist | John Peter Smith Hospital, 1500 S. Main St., Fort Worth, TX 76104 | 2019-12-13 |
| 1104480656 | Swarnalaxmi Umapathy | Student in an Organized Health Care Education/Training Program | 900 8th Avenue, Fort Worth, TX 76104 | 2019-04-30 |
| 1881189132 | Mega Surgical Assistants LLC | Specialist/Technologist, Other | 1301pennsylvania, Fort Worth, TX 76104 | 2018-06-28 |
| 1356848899 | Tricia Kelly | Nurse Practitioner | 1325 Pennsylvania Avenue Suite 560, Fort Worth, TX 76104 | 2018-04-11 |
| 1952820979 | Modern Vein Clinic | Internal Medicine | 757 8th Avenue, Suite A, Forth Worth, TX 76104 | 2017-09-11 |
| 1790207165 | Vanessa Abbood | Dietitian, Registered | 900 Eighth Ave, Fns Department, Fort Worth, TX 76104 | 2017-07-07 |
| 1922537562 | Nicole Marie Tod | Student in an Organized Health Care Education/Training Program | 1500 S Main Street, Fort Worth, TX 76104 | 2017-06-07 |
| 1770025934 | Micah Bonola | Chiropractor | 1300 W. Rosedale St, Ste. A, Fort Worth, TX 76104 | 2016-11-04 |
| 1518315894 | United Bioscience, LLC. | Clinical Medical Laboratory | 901 W. Leuda St., B, Fort Worth, TX 76104 | 2016-05-27 |
| Find all providers in zip 76104 | ||||
| Taxonomy Code | 261QP3300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Pain |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093205858 | Evolution Pain Centers LLC | Clinic/Center | 6789 Camp Bowie Blvd, Fort Worth, TX 76116-7112 | 2018-05-16 |
| 1922457035 | Maple Anesthesia Management, LLC | Clinic/Center | 2001 Cooper St, Fort Worth, TX 76104-2529 | 2016-06-09 |
| 1093164196 | Spruce Anesthesia Management, LLC | Clinic/Center | 2001 Cooper St, Fort Worth, TX 76104-2529 | 2016-06-09 |
| 1902255003 | Elm Anesthesia Management, LLC | Clinic/Center | 2001 Cooper St, Fort Worth, TX 76104-2529 | 2016-06-09 |
| 1255786786 | Hatch Anesthesia Management LLC | Clinic/Center | 2001 Cooper St, Fort Worth, TX 76104-2529 | 2016-05-03 |
| 1609237072 | Eames Pain and Anesthesia Management | Clinic/Center | 1301 N Beach St, Fort Worth, TX 76111-6613 | 2016-03-14 |
| 1093190803 | Elite Pain Management & Monitoring | Clinic/Center | 6805 Ne Loop 820, Suite 408, Fort Worth, TX 76180-6687 | 2015-07-22 |
| 1356720718 | Texas Health Care Pain Management | Clinic/Center | 1307 8th Ave, Suite 506, Fort Worth, TX 76104-4137 | 2015-05-19 |
| 1942634662 | Harper Interventional Pain Center LLC | Clinic/Center | 1201 Summit Ave, Suite 400, Fort Worth, TX 76102-4413 | 2013-08-29 |
| 1356685861 | Marsh Interventional Pain Center, LLC | Clinic/Center | 1201 Summit Ave, Suite 400, Fort Worth, TX 76102-4413 | 2012-11-21 |
| Find all providers in FORT WORTH | ||||
| City | FORT WORTH |
| Zip Code | 76104 |
Please comment or provide details below to improve the information on TEXAS VARICOSE VEIN CLINIC OF FORT WORTH, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.