Provider Demographics
NPI:1871032201
Name:HEART & VASCULAR DIAGNOSTIC CLINIC PA
Entity Type:Organization
Organization Name:HEART & VASCULAR DIAGNOSTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:FELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-674-6352
Mailing Address - Street 1:710 GASLIGHT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3153
Mailing Address - Country:US
Mailing Address - Phone:936-639-0988
Mailing Address - Fax:
Practice Address - Street 1:710 GASLIGHT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3153
Practice Address - Country:US
Practice Address - Phone:936-639-0988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9325207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty