1821076167 NPI number — CARDIOLOGY CARE CONSULTANTS, PA

Table of content: (NPI 1821076167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821076167 NPI number — CARDIOLOGY CARE CONSULTANTS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIOLOGY CARE CONSULTANTS, 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:
1821076167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7814 GATEWAY BLVD E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79915-1815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-542-2352
Provider Business Mailing Address Fax Number:
915-593-8559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 N MESA ST
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-1118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-542-2352
Provider Business Practice Location Address Fax Number:
915-313-6692
Provider Enumeration Date:
01/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUINTANA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
915-542-2352

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085B0100X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: G0416 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q2471 . This is a "RR MCR GRP #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 083526602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00K58Q . This is a "BX/BS TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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