Provider Demographics
NPI:1336704840
Name:COLLIN COUNTY HEART CENTER PLLC
Entity Type:Organization
Organization Name:COLLIN COUNTY HEART CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILAKAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-782-9860
Mailing Address - Street 1:3400 COIT RD # 262609
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3771
Mailing Address - Country:US
Mailing Address - Phone:469-782-9860
Mailing Address - Fax:469-461-3581
Practice Address - Street 1:4100 W 15TH ST STE 110
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5826
Practice Address - Country:US
Practice Address - Phone:469-782-9860
Practice Address - Fax:469-461-3581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX352396101Medicaid