Provider Demographics
NPI:1831122589
Name:CARDIAC CARE, P.A.
Entity Type:Organization
Organization Name:CARDIAC CARE, P.A.
Other - Org Name:CARDIAC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:POONGODHAI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMACHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-968-5000
Mailing Address - Street 1:2291 NORTHWEST LOOP
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-1701
Mailing Address - Country:US
Mailing Address - Phone:254-968-5000
Mailing Address - Fax:254-968-5725
Practice Address - Street 1:2291 NORTHWEST LOOP
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1701
Practice Address - Country:US
Practice Address - Phone:254-968-5000
Practice Address - Fax:254-968-5725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9046207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00589ZMedicare PIN
TXH31630Medicare UPIN