Provider Demographics
NPI:1639107659
Name:TEXOMA CARDIOVASCULAR SURGEONS LLP
Entity Type:Organization
Organization Name:TEXOMA CARDIOVASCULAR SURGEONS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-868-4595
Mailing Address - Street 1:600 E TAYLOR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2881
Mailing Address - Country:US
Mailing Address - Phone:903-868-4595
Mailing Address - Fax:903-868-4597
Practice Address - Street 1:600 E TAYLOR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2881
Practice Address - Country:US
Practice Address - Phone:903-868-4595
Practice Address - Fax:903-868-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0095EZOtherBLUE CROSS BLUE SHIELD
TX080222501Medicaid
TX00246RMedicare ID - Type Unspecified