Provider Demographics
NPI:1730450115
Name:TEXAS PHLEBOLOGY PA
Entity type:Organization
Organization Name:TEXAS PHLEBOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMORUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-593-8460
Mailing Address - Street 1:PO BOX 971
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0971
Mailing Address - Country:US
Mailing Address - Phone:847-593-8460
Mailing Address - Fax:
Practice Address - Street 1:6149 WINDHAVEN PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8274
Practice Address - Country:US
Practice Address - Phone:630-725-2730
Practice Address - Fax:630-725-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB155426Medicare PIN
TX292521Medicare PIN
TXTXB156437Medicare PIN