1417158239 NPI number — HEART SPECIALISTS OF TEXAS PA

Table of content: (NPI 1417158239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417158239 NPI number — HEART SPECIALISTS OF TEXAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART SPECIALISTS OF TEXAS PA
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:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417158239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 420848
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEL RIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-775-6600
Provider Business Mailing Address Fax Number:
830-775-6400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1109 AVE K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEL RIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-775-6600
Provider Business Practice Location Address Fax Number:
830-775-6400
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VAN
Authorized Official First Name:
TUONG
Authorized Official Middle Name:
BA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
830-775-6600

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  H0900 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: A47882 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 128395401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46KK . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: N32K . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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