Provider Demographics
NPI:1346324647
Name:TEXOMA HEART GROUP, PA
Entity Type:Organization
Organization Name:TEXOMA HEART GROUP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:903-465-3624
Mailing Address - Street 1:5026 POOL ROAD
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4595
Mailing Address - Country:US
Mailing Address - Phone:903-465-3624
Mailing Address - Fax:903-465-3973
Practice Address - Street 1:5026 POOL ROAD
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4595
Practice Address - Country:US
Practice Address - Phone:903-465-3624
Practice Address - Fax:903-465-3973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080380101Medicaid
TX080380101Medicaid
TX00332KMedicare ID - Type UnspecifiedMEDICARE NUMBER