Provider Demographics
NPI:1548418973
Name:TEXAS CARDIOVASCULAR CONSULTANTS, PA
Entity Type:Organization
Organization Name:TEXAS CARDIOVASCULAR CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:TYPHAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-615-6218
Mailing Address - Street 1:5301 RIATA PARK COURT
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3438
Mailing Address - Country:US
Mailing Address - Phone:512-615-6254
Mailing Address - Fax:512-615-0459
Practice Address - Street 1:441 HIGHWAY 71 W
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3931
Practice Address - Country:US
Practice Address - Phone:512-617-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS CARDIOVASCULAR CONSULTANTS, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-27
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00859RMedicare PIN