Provider Demographics
NPI:1487983771
Name:VIKAS JAIN MD PA CORP
Entity type:Organization
Organization Name:VIKAS JAIN MD PA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACC
Authorized Official - Phone:817-657-1667
Mailing Address - Street 1:802 WORTHING CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8877
Mailing Address - Country:US
Mailing Address - Phone:817-657-1667
Mailing Address - Fax:817-416-9933
Practice Address - Street 1:802 WORTHING CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8877
Practice Address - Country:US
Practice Address - Phone:817-657-1667
Practice Address - Fax:817-416-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLL468207UN0901X, 2085R0204X
TXL4468207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty