Provider Demographics
NPI:1740613116
Name:CCA CATH LAB LLC
Entity Type:Organization
Organization Name:CCA CATH LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-354-9764
Mailing Address - Street 1:6200 W I 40
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-2512
Mailing Address - Country:US
Mailing Address - Phone:806-354-9764
Mailing Address - Fax:806-354-2728
Practice Address - Street 1:6200 W I 40
Practice Address - Street 2:SUITE 200
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2512
Practice Address - Country:US
Practice Address - Phone:806-354-9764
Practice Address - Fax:806-354-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty