1598455214 NPI number — WEST TEXAS HEART & VASCULAR, PLLC

Table of content: (NPI 1598455214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598455214 NPI number — WEST TEXAS HEART & VASCULAR, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST TEXAS HEART & VASCULAR, PLLC
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:
WEST TEXAS HEART & VASCULAR
Provider Other Organization Name Type Code:
3
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:
1598455214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4324 23RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79410-1812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-701-4263
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4321 MARSHA SHARP FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79407-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-686-3500
Provider Business Practice Location Address Fax Number:
806-368-7928
Provider Enumeration Date:
05/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
BLAKE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
806-701-4263

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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