Provider Demographics
NPI:1386653632
Name:CARDIOLOGY ASSOCIATES OF WEST TEXAS
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF WEST TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MILTIADIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-655-7969
Mailing Address - Street 1:3180 EXECUTIVE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6837
Mailing Address - Country:US
Mailing Address - Phone:325-944-1240
Mailing Address - Fax:
Practice Address - Street 1:3180 EXECUTIVE DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6837
Practice Address - Country:US
Practice Address - Phone:325-944-1240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RI0011X
TXK0890207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183372501Medicaid
TX0044NTOtherBC/BS GROUP
TX45D1081287OtherCLIA NUMBER
TX45D1081287OtherCLIA NUMBER