Provider Demographics
NPI:1629288543
Name:WICHITA FALLS CARDIAC CARE PA
Entity Type:Organization
Organization Name:WICHITA FALLS CARDIAC CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VENKATESWARLU
Authorized Official - Middle Name:
Authorized Official - Last Name:THOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-723-6400
Mailing Address - Street 1:1518 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4405
Mailing Address - Country:US
Mailing Address - Phone:940-723-6400
Mailing Address - Fax:940-723-6403
Practice Address - Street 1:1518 10TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4405
Practice Address - Country:US
Practice Address - Phone:940-723-6400
Practice Address - Fax:940-723-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty