1295987337 NPI number — CARDIOVASCULAR CONSULTANTS OF NORTH TEXAS, LLP

Table of content: (NPI 1295987337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295987337 NPI number — CARDIOVASCULAR CONSULTANTS OF NORTH TEXAS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR CONSULTANTS OF NORTH TEXAS, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
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NPI Number Information

NPI Number:
1295987337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 W COLLEGE ST
Provider Second Line Business Mailing Address:
SUITE 680
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051-3581
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-912-8400
Provider Business Mailing Address Fax Number:
817-912-8410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2340 E TRINITY MILLS RD
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75006-1942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-912-8400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PETTIJOHN
Authorized Official First Name:
TRENT
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
469-800-4400

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 147632701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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