Provider Demographics
NPI:1568428381
Name:MESQUITE HEART CENTER, P.A.
Entity Type:Organization
Organization Name:MESQUITE HEART CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALEEM
Authorized Official - Middle Name:H
Authorized Official - Last Name:MALLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-279-3500
Mailing Address - Street 1:PO BOX 850347
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-0347
Mailing Address - Country:US
Mailing Address - Phone:972-279-3500
Mailing Address - Fax:972-279-3505
Practice Address - Street 1:1601 N. BELT LINE RD.
Practice Address - Street 2:SUITE C
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1791
Practice Address - Country:US
Practice Address - Phone:972-279-3500
Practice Address - Fax:972-279-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6487207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0086EBOtherBCBS
TX109366803Medicaid
DD7678Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX00326RMedicare PIN