Provider Demographics
NPI:1942845565
Name:PREFERRED CARDIO CHECKUP MANAGEMENT LLC
Entity Type:Organization
Organization Name:PREFERRED CARDIO CHECKUP MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-281-7328
Mailing Address - Street 1:211 BENT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-6353
Mailing Address - Country:US
Mailing Address - Phone:972-281-7328
Mailing Address - Fax:
Practice Address - Street 1:211 BENT CREEK DR
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-6353
Practice Address - Country:US
Practice Address - Phone:972-281-7328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty