1578854436 NPI number — CARDIOVASCULAR SPECIALISTS OF TEXAS, P.A

Table of content: (NPI 1578854436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578854436 NPI number — CARDIOVASCULAR SPECIALISTS OF TEXAS, P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOVASCULAR SPECIALISTS OF TEXAS, P.A
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:
1578854436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7215 WYOMING SPGS
Provider Second Line Business Mailing Address:
BUILDING 1, SUITE 100
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78681-4312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-807-3160
Provider Business Mailing Address Fax Number:
512-494-1990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 GOLDER AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79761-5043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-807-3160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CHUTICH
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BUSINESS SERVICES
Authorized Official Telephone Number:
512-615-6224

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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