1457517617 NPI number — SOUTHWEST CARDIOVASCULAR INTERVENTION CLINIC, PA

Table of content: (NPI 1457517617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457517617 NPI number — SOUTHWEST CARDIOVASCULAR INTERVENTION CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST CARDIOVASCULAR INTERVENTION CLINIC, 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:
1457517617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1508 N ZARAGOZA RD STE ABCD
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:
79936-8034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-298-5425
Provider Business Mailing Address Fax Number:
915-298-5430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1508 N ZARAGOZA RD STE ABCD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936-8034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-298-5425
Provider Business Practice Location Address Fax Number:
915-298-5430
Provider Enumeration Date:
08/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AMADI
Authorized Official First Name:
CHIKEZIE
Authorized Official Middle Name:
CHIDIEBERE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
915-373-9066

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  M9797 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com