Provider Demographics
NPI:1013986470
Name:SRIRAM & SHONALATHA SUDARSHAN NORTH TEXAS CARDIOLOGY CENTER, LLP
Entity Type:Organization
Organization Name:SRIRAM & SHONALATHA SUDARSHAN NORTH TEXAS CARDIOLOGY CENTER, LLP
Other - Org Name:NORTH TEXAS CARDIOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SRIRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDARSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-766-4488
Mailing Address - Street 1:2101 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4133
Mailing Address - Country:US
Mailing Address - Phone:940-766-4488
Mailing Address - Fax:940-322-5765
Practice Address - Street 1:2101 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4133
Practice Address - Country:US
Practice Address - Phone:940-766-4488
Practice Address - Fax:940-322-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RC0000X
TX661133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00MT39Medicare PIN