Provider Demographics
NPI:1134321532
Name:TEXAS CARDIOVASCULAR CONSULTANTS-SAN ANGELO, PA
Entity Type:Organization
Organization Name:TEXAS CARDIOVASCULAR CONSULTANTS-SAN ANGELO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:512-441-1633
Mailing Address - Street 1:42 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4317
Mailing Address - Country:US
Mailing Address - Phone:512-441-1633
Mailing Address - Fax:512-615-0459
Practice Address - Street 1:102 N MAGDALEN ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5400
Practice Address - Country:US
Practice Address - Phone:800-530-4143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty