Provider Demographics
NPI:1326043043
Name:CARDIAC CARE OF TEXAS PLLC
Entity Type:Organization
Organization Name:CARDIAC CARE OF TEXAS PLLC
Other - Org Name:TEXAS CARDIAC CARE PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-448-9522
Mailing Address - Street 1:1116 OAK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6274
Mailing Address - Country:US
Mailing Address - Phone:817-448-9522
Mailing Address - Fax:817-448-9523
Practice Address - Street 1:1116 OAK VALLEY RD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-6274
Practice Address - Country:US
Practice Address - Phone:817-448-9522
Practice Address - Fax:817-448-9523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007463251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679032Medicare ID - Type Unspecified