Provider Demographics
NPI:1013075415
Name:SILVER HEART CARDIOLOGY MD PA
Entity Type:Organization
Organization Name:SILVER HEART CARDIOLOGY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIFUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-584-1672
Mailing Address - Street 1:3023 PERRYTON PKWY
Mailing Address - Street 2:STE 205
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2821
Mailing Address - Country:US
Mailing Address - Phone:806-669-3003
Mailing Address - Fax:806-669-3450
Practice Address - Street 1:3023 PERRYTON PKWY
Practice Address - Street 2:STE 205
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2821
Practice Address - Country:US
Practice Address - Phone:806-669-3003
Practice Address - Fax:806-274-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA91573Medicare UPIN