Provider Demographics
NPI:1205849114
Name:MIDLAND CARDIAC CLINIC, PA
Entity Type:Organization
Organization Name:MIDLAND CARDIAC CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PANKAJ
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:432-522-1234
Mailing Address - Street 1:3403 ANDREWS HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5132
Mailing Address - Country:US
Mailing Address - Phone:432-522-1234
Mailing Address - Fax:432-522-2950
Practice Address - Street 1:3403 ANDREWS HWY STE 300
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-5132
Practice Address - Country:US
Practice Address - Phone:432-522-1234
Practice Address - Fax:432-522-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081054101Medicaid