Provider Demographics
NPI:1205810991
Name:BT HEART AND VASCULAR CENTER, PLLC
Entity type:Organization
Organization Name:BT HEART AND VASCULAR CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGHIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-2500
Mailing Address - Street 1:223 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27028-2038
Mailing Address - Country:US
Mailing Address - Phone:336-765-2500
Mailing Address - Fax:336-765-2555
Practice Address - Street 1:223 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MOCKSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27028-2038
Practice Address - Country:US
Practice Address - Phone:336-765-2500
Practice Address - Fax:336-765-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC124240207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCDC6367OtherMEDICARE RR
NC116217OtherAETNA
NC5900341Medicaid
VADC6368OtherMEDICARE RR
NC5900341Medicaid
NC2341598Medicare PIN