Provider Demographics
NPI:1508136052
Name:FEDERICO MAESE MD PA
Entity Type:Organization
Organization Name:FEDERICO MAESE MD PA
Other - Org Name:FERRIS HEART CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FEDERICO
Authorized Official - Middle Name:
Authorized Official - Last Name:MAESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-719-3690
Mailing Address - Street 1:269 E OVILLA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-2616
Mailing Address - Country:US
Mailing Address - Phone:469-719-3690
Mailing Address - Fax:
Practice Address - Street 1:269 E OVILLA RD STE 100
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2616
Practice Address - Country:US
Practice Address - Phone:469-719-3690
Practice Address - Fax:469-719-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4319174400000X
207RC0000X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXJ4319OtherLICENSE TX
TX131230801Medicaid
TXTXB145190OtherMEDICARE PTAN
TX0067CDMedicare PIN