Provider Demographics
NPI:1598455214
Name:WEST TEXAS HEART & VASCULAR, PLLC
Entity Type:Organization
Organization Name:WEST TEXAS HEART & VASCULAR, PLLC
Other - Org Name:WEST TEXAS HEART & VASCULAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CASC, CMPE
Authorized Official - Phone:806-701-4263
Mailing Address - Street 1:4324 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1812
Mailing Address - Country:US
Mailing Address - Phone:806-701-4263
Mailing Address - Fax:
Practice Address - Street 1:4321 MARSHA SHARP FWY
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2504
Practice Address - Country:US
Practice Address - Phone:806-686-3500
Practice Address - Fax:806-368-7928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty