Provider Demographics
NPI:1215178967
Name:CARDIOVASCULAR SPECIALISTS OF TEXAS PA
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS OF TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:N
Authorized Official - Last Name:CHUTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-615-6224
Mailing Address - Street 1:7215 WYOMING SPRINGS DR.
Mailing Address - Street 2:BLDG. 1, STE. 100
Mailing Address - City:ROND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4311
Mailing Address - Country:US
Mailing Address - Phone:512-615-6224
Mailing Address - Fax:512-615-0459
Practice Address - Street 1:1301 W 38TH ST
Practice Address - Street 2:SUITE 705
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1016
Practice Address - Country:US
Practice Address - Phone:512-807-3160
Practice Address - Fax:512-615-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A3852Medicare PIN