1770594939 NPI number — ROUND ROCK CARDIOLOGY, PA

Table of content: (NPI 1770594939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770594939 NPI number — ROUND ROCK CARDIOLOGY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROUND ROCK CARDIOLOGY, 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:
1770594939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 268840
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73126-8840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-244-9944
Provider Business Mailing Address Fax Number:
512-244-9977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16010 PARK VALLEY DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-3574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-244-9944
Provider Business Practice Location Address Fax Number:
512-244-9977
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
512-342-0455

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  L2043 , 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: 0078GN . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: DE3953 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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