1538304613 NPI number — HEART TO HEART CARDIOVASCULAR ASSOCIATES

Table of content: (NPI 1538304613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538304613 NPI number — HEART TO HEART CARDIOVASCULAR ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART TO HEART CARDIOVASCULAR ASSOCIATES
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:
1538304613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 RUSSELL BLVD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NACOGDOCHES
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75965-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-560-4327
Provider Business Mailing Address Fax Number:
866-927-4221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 RUSSELL BLVD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NACOGDOCHES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75965-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-560-4327
Provider Business Practice Location Address Fax Number:
888-927-4221
Provider Enumeration Date:
12/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOUDENSLAGER
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
936-560-4327

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  L2126 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2628425 . This is a "CIGNA HMO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4130361 . This is a "BCBS BLUE LINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 145768101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8R5784 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1114931573 . This is a "NPI TYPE 1" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00209257 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7859289 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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