Provider Demographics
NPI:1922275361
Name:NORTH TEXAS HEART CENTER PA
Entity Type:Organization
Organization Name:NORTH TEXAS HEART CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASIFKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-361-3300
Mailing Address - Street 1:4510 MEDICAL CENTER DR
Mailing Address - Street 2:STE 303
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1650
Mailing Address - Country:US
Mailing Address - Phone:214-726-9292
Mailing Address - Fax:972-542-7343
Practice Address - Street 1:4510 MEDICAL CENTER DR
Practice Address - Street 2:STE 303
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1650
Practice Address - Country:US
Practice Address - Phone:214-726-9292
Practice Address - Fax:972-542-7343
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH TEXAS HEART CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-14
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U37MMedicare UPIN