1326260803 NPI number — INTERNAL MEDICINE CARDIOVASCULAR SERVICES, LLC

Table of content: DR. EDWARD J. WHEELER M.D. (NPI 1376517953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326260803 NPI number — INTERNAL MEDICINE CARDIOVASCULAR SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE CARDIOVASCULAR SERVICES, LLC
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326260803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1933 FM 115
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-588-2033
Provider Business Mailing Address Fax Number:
903-588-2036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1933 FM 115
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-588-2033
Provider Business Practice Location Address Fax Number:
903-588-2036
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OSBORNE
Authorized Official First Name:
ISAAC
Authorized Official Middle Name:
J.T.
Authorized Official Title or Position:
M.D
Authorized Official Telephone Number:
903-588-2033

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  L4196 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8G1990 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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