Provider Demographics
NPI:1164734059
Name:CARDIOVASCULAR SPECIALISTS OF TEXAS
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-615-6224
Mailing Address - Street 1:7000 N MOPAC EXPY
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3027
Mailing Address - Country:US
Mailing Address - Phone:512-615-6200
Mailing Address - Fax:
Practice Address - Street 1:206 CR 340-A
Practice Address - Street 2:BLDG. 4, STE. A
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611
Practice Address - Country:US
Practice Address - Phone:512-756-0900
Practice Address - Fax:512-756-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4026Medicare PIN