Provider Demographics
NPI:1477814028
Name:WEST TEXAS CARDIOLOGY PA
Entity Type:Organization
Organization Name:WEST TEXAS CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MF
Authorized Official - Phone:432-331-9900
Mailing Address - Street 1:501 GOLDER AVE STE 203A
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4440
Mailing Address - Country:US
Mailing Address - Phone:432-331-9900
Mailing Address - Fax:432-331-9959
Practice Address - Street 1:501 GOLDER AVE STE 203A
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4440
Practice Address - Country:US
Practice Address - Phone:432-331-9900
Practice Address - Fax:432-331-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty