Provider Demographics
NPI:1417248881
Name:CARDIOVASCULAR SPECIALISTS OF TEXAS, P.A
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS OF TEXAS, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUTICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-615-6224
Mailing Address - Street 1:7215 WYOMING SPGS
Mailing Address - Street 2:BUILDING 1, SUITE 100
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4312
Mailing Address - Country:US
Mailing Address - Phone:512-807-3160
Mailing Address - Fax:512-494-1990
Practice Address - Street 1:4810 N LOOP 289
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3025
Practice Address - Country:US
Practice Address - Phone:512-807-3160
Practice Address - Fax:512-494-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty