Provider Demographics
NPI:1033142039
Name:TEXOMA CARDIO DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:TEXOMA CARDIO DIAGNOSTICS LLC
Other - Org Name:TEXOMA CARDIO-DIAGNOSTICS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT CHIEF SONOGRAPHER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS, RCS, RVS
Authorized Official - Phone:580-775-3246
Mailing Address - Street 1:2303 BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-8023
Mailing Address - Country:US
Mailing Address - Phone:580-924-6052
Mailing Address - Fax:
Practice Address - Street 1:2303 BRYAN RD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-8023
Practice Address - Country:US
Practice Address - Phone:580-924-6052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty