Provider Demographics
NPI:1003160045
Name:PREVENTATIVE AND THERAPEUTIC CARDIOVASCULAR ASSOCIATES
Entity type:Organization
Organization Name:PREVENTATIVE AND THERAPEUTIC CARDIOVASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-998-0803
Mailing Address - Street 1:PO BOX 261285
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-1285
Mailing Address - Country:US
Mailing Address - Phone:972-596-6400
Mailing Address - Fax:
Practice Address - Street 1:1708 COIT RD
Practice Address - Street 2:SUITE 220-B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-5024
Practice Address - Country:US
Practice Address - Phone:972-596-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4465261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty