Provider Demographics
NPI:1376543637
Name:CARDIOLOGY AND INTERVENTIONAL VASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:CARDIOLOGY AND INTERVENTIONAL VASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-369-3613
Mailing Address - Street 1:7150 GREENVILLE AVE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-7900
Mailing Address - Country:US
Mailing Address - Phone:214-369-3613
Mailing Address - Fax:214-706-2019
Practice Address - Street 1:7150 GREENVILLE AVE
Practice Address - Street 2:SUITE 650
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-7900
Practice Address - Country:US
Practice Address - Phone:214-369-3613
Practice Address - Fax:214-706-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0845208-01Medicaid
TXCO1163OtherRAILROAD MEDICARE
TX0845208-01Medicaid