1720108053 NPI number — FRISCO HEART AND VASCULAR INSTITUTE PA

Table of content: (NPI 1720108053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720108053 NPI number — FRISCO HEART AND VASCULAR INSTITUTE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRISCO HEART AND VASCULAR INSTITUTE 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:
1720108053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5963 DRIPPING SPRINGS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-4037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-618-8833
Provider Business Mailing Address Fax Number:
972-394-0707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 COIT RD STE 309
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75035-0511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-362-6543
Provider Business Practice Location Address Fax Number:
469-362-6545
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOFFETT
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
G
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
469-362-6543

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  K2507 , 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)





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