Provider Demographics
NPI:1053640383
Name:NORTHWEST TEXAS CARDIOLOGY ASSOCIATES PA
Entity Type:Organization
Organization Name:NORTHWEST TEXAS CARDIOLOGY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAGADISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PUPPALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-355-2987
Mailing Address - Street 1:1329 CILANTRO DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-3492
Mailing Address - Country:US
Mailing Address - Phone:972-355-2987
Mailing Address - Fax:214-221-5600
Practice Address - Street 1:1329 CILANTRO DR
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-3492
Practice Address - Country:US
Practice Address - Phone:972-355-2987
Practice Address - Fax:214-221-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH00117Medicare UPIN