Provider Demographics
NPI:1649457664
Name:COMPREHENSIVE CARDIAC & VASCULAR INTERVENTIONAL GROUP
Entity type:Organization
Organization Name:COMPREHENSIVE CARDIAC & VASCULAR INTERVENTIONAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-946-9898
Mailing Address - Street 1:221 W COLORADO BLVD
Mailing Address - Street 2:SUITE 933
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-2363
Mailing Address - Country:US
Mailing Address - Phone:214-946-9898
Mailing Address - Fax:214-946-7332
Practice Address - Street 1:221 W COLORADO BLVD
Practice Address - Street 2:SUITE 933
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-2363
Practice Address - Country:US
Practice Address - Phone:214-946-9898
Practice Address - Fax:214-946-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0095QWOtherBCBS
TXTXB159929Medicare PIN
TX00Z139Medicare PIN