Provider Demographics
NPI:1801866579
Name:SOUTHWEST CARDIAC ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHWEST CARDIAC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUNUKULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-226-0505
Mailing Address - Street 1:5308 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1122
Mailing Address - Country:US
Mailing Address - Phone:972-226-0505
Mailing Address - Fax:972-289-9640
Practice Address - Street 1:5308 NORTH GALLOWAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150
Practice Address - Country:US
Practice Address - Phone:972-226-0505
Practice Address - Fax:972-289-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082116701Medicaid
00D926Medicare ID - Type Unspecified