Provider Demographics
NPI:1881841468
Name:PEDI CARDIO OF WEST TEXAS
Entity Type:Organization
Organization Name:PEDI CARDIO OF WEST TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:CEM
Authorized Official - Middle Name:
Authorized Official - Last Name:NASUHOGLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-332-0052
Mailing Address - Street 1:850 TOWER DR
Mailing Address - Street 2:SUITE112
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4238
Mailing Address - Country:US
Mailing Address - Phone:432-332-0052
Mailing Address - Fax:
Practice Address - Street 1:850 TOWER DR
Practice Address - Street 2:SUITE # 112
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4238
Practice Address - Country:US
Practice Address - Phone:432-332-0052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM12562080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty