Provider Demographics
NPI:1336118249
Name:CAPITAL CARDIOVASCULAR CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:CAPITAL CARDIOVASCULAR CONSULTANTS, PLLC
Other - Org Name:CAPITAL CARDIOVASCULAR SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL STAFF COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:NACK
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:512-334-7855
Mailing Address - Street 1:4207 JAMES CASEY ST
Mailing Address - Street 2:STE 215
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3300
Mailing Address - Country:US
Mailing Address - Phone:512-445-5998
Mailing Address - Fax:512-445-6095
Practice Address - Street 1:4207 JAMES CASEY ST
Practice Address - Street 2:STE 215
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3300
Practice Address - Country:US
Practice Address - Phone:512-445-5998
Practice Address - Fax:512-445-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153865403Medicaid
TX0093HZOtherBCBS GROUP NUMBER
TX153865403Medicaid