Provider Demographics
NPI:1306016225
Name:WICHITA HEART AND VASCULAR CENTER, PLLC
Entity Type:Organization
Organization Name:WICHITA HEART AND VASCULAR CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-264-3222
Mailing Address - Street 1:1631 11TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4320
Mailing Address - Country:US
Mailing Address - Phone:940-264-3222
Mailing Address - Fax:940-264-3225
Practice Address - Street 1:1631 11TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4320
Practice Address - Country:US
Practice Address - Phone:940-264-3222
Practice Address - Fax:940-264-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y906Medicare PIN