Provider Demographics
NPI:1609804301
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:MS
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 CT
Mailing Address - Street 2:BLDG D, SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3438
Mailing Address - Country:US
Mailing Address - Phone:512-617-6000
Mailing Address - Fax:512-615-0459
Practice Address - Street 1:5301 RIATA PARK CT
Practice Address - Street 2:BLDG D, SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-3438
Practice Address - Country:US
Practice Address - Phone:512-617-6000
Practice Address - Fax:512-615-0459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RC0000X, 207RC0001X, 207RI0011X
207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153163402Medicaid
TX083432702Medicaid
TX00859RMedicare PIN
TX00K17JMedicare PIN