Provider Demographics
NPI:1407053234
Name:ROCKWALL CARDIO-PULMONARY SERVICES INC
Entity Type:Organization
Organization Name:ROCKWALL CARDIO-PULMONARY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:SUZZETTE
Authorized Official - Last Name:AARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-581-6100
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-0009
Mailing Address - Country:US
Mailing Address - Phone:817-581-6100
Mailing Address - Fax:415-795-4434
Practice Address - Street 1:10400 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2297
Practice Address - Country:US
Practice Address - Phone:214-771-0117
Practice Address - Fax:415-795-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2484261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID
TX=========OtherTAX ID