1447953351 NPI number — TEXAS CARDIAC AND VASCULAR SPECIALISTS PA

Table of content: (NPI 1447953351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447953351 NPI number — TEXAS CARDIAC AND VASCULAR SPECIALISTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS CARDIAC AND VASCULAR SPECIALISTS 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:
1447953351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
718 LEXINGTON AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78212-4790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-420-8671
Provider Business Mailing Address Fax Number:
210-899-1958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
718 LEXINGTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78212-4768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-420-8671
Provider Business Practice Location Address Fax Number:
210-899-1958
Provider Enumeration Date:
03/22/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HAYNES
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
726-208-3118

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 472017901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 472013801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 459752801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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