Provider Demographics
NPI:1194852418
Name:MISSION CARDIOVASCULAR CONSULTANTS
Entity Type:Organization
Organization Name:MISSION CARDIOVASCULAR CONSULTANTS
Other - Org Name:NEW BRAUNFELS CARDIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-620-1272
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-0949
Mailing Address - Country:US
Mailing Address - Phone:830-620-1272
Mailing Address - Fax:830-620-1274
Practice Address - Street 1:1626 COMMON ST
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3156
Practice Address - Country:US
Practice Address - Phone:830-620-1272
Practice Address - Fax:830-620-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ18642086S0129X
207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079747402Medicaid
TX079747402Medicaid