Provider Demographics
NPI:1700918356
Name:AMARILLO CARDIOVASCULAR & THORACIC SURGERY, P.A.
Entity Type:Organization
Organization Name:AMARILLO CARDIOVASCULAR & THORACIC SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALZEERAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-463-1712
Mailing Address - Street 1:1301 S. COULTER, SUITE 103
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1764
Mailing Address - Country:US
Mailing Address - Phone:806-463-1712
Mailing Address - Fax:806-463-1715
Practice Address - Street 1:1301 S. COULTER, SUITE 103
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1764
Practice Address - Country:US
Practice Address - Phone:806-463-1712
Practice Address - Fax:806-463-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3727208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080105201Medicaid
TX080105201Medicaid