1407830672 NPI number — BT HEART AND VASCULAR CENTER, PLLC

Table of content: (NPI 1407830672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407830672 NPI number — BT HEART AND VASCULAR CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BT HEART AND VASCULAR CENTER, 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:
Provider Other Organization Name Type Code:
6
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:
1407830672
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 EAST BLUE RIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24171-1560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-692-2540
Provider Business Mailing Address Fax Number:
336-719-7898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 EAST BLUE RIDGE ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24171-1560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-692-2540
Provider Business Practice Location Address Fax Number:
276-694-4206
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TAGHIZADEH
Authorized Official First Name:
BEHZAD
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
336-765-2500

Provider Taxonomy Codes

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

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

  • Identifier: 116217 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 249989 . This is a "SOUTHERN HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: DC09298 . This is a "MEDICARE RR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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