Provider Demographics
NPI:1497367015
Name:TRIDENT HEART AND VASCULAR, PLLC
Entity Type:Organization
Organization Name:TRIDENT HEART AND VASCULAR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAPRAKASAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-882-6868
Mailing Address - Street 1:5801 OAKBEND TRL STE 270
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3922
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5801 OAKBEND TRL STE 270
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3922
Practice Address - Country:US
Practice Address - Phone:817-882-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-17
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty