Provider Demographics
NPI:1497943138
Name:TEXAS COAST CARDIOVASCULAR LLC
Entity Type:Organization
Organization Name:TEXAS COAST CARDIOVASCULAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIX-EMPERADOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-412-7503
Mailing Address - Street 1:597 W SESAME DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8364
Mailing Address - Country:US
Mailing Address - Phone:956-412-7503
Mailing Address - Fax:956-423-0914
Practice Address - Street 1:597 W SESAME DR
Practice Address - Street 2:SUITE C
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8364
Practice Address - Country:US
Practice Address - Phone:956-412-7503
Practice Address - Fax:956-423-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3283207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039RAOtherBCBS
TX8AW384OtherBCBS
TX1505398-01Medicaid
TX1505398-02Medicaid
TX060068750OtherRAILROAD MEDICARE
TX0035HKOtherBCBS
TX1757668-01Medicaid
TX0035HKOtherBCBS