Provider Demographics
NPI:1558514737
Name:HEART HEALTH CENTER OF NORTH TEXAS PA
Entity Type:Organization
Organization Name:HEART HEALTH CENTER OF NORTH TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:NASRULLAH
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-270-7005
Mailing Address - Street 1:1600 REPUBLIC PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6919
Mailing Address - Country:US
Mailing Address - Phone:972-270-7005
Mailing Address - Fax:
Practice Address - Street 1:1600 REPUBLIC PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6919
Practice Address - Country:US
Practice Address - Phone:972-270-7005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9129207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035954905Medicaid
G17209Medicare UPIN