Provider Demographics
NPI:1700017837
Name:HAVANT, PLLC
Entity Type:Organization
Organization Name:HAVANT, PLLC
Other - Org Name:HEART AND VASCULAR ASSOCIATES OF NORTH TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-362-6543
Mailing Address - Street 1:3900 W 15TH ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7751
Mailing Address - Country:US
Mailing Address - Phone:972-596-5522
Mailing Address - Fax:469-362-6545
Practice Address - Street 1:2821 E PRESIDENT GEORGE BUSH HWY
Practice Address - Street 2:SUITE 306
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4266
Practice Address - Country:US
Practice Address - Phone:972-234-9100
Practice Address - Fax:469-362-6545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5053Medicare PIN