Provider Demographics
NPI:1770594939
Name:ROUND ROCK CARDIOLOGY, PA
Entity type:Organization
Organization Name:ROUND ROCK CARDIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-342-0455
Mailing Address - Street 1:PO BOX 268840
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8840
Mailing Address - Country:US
Mailing Address - Phone:512-244-9944
Mailing Address - Fax:512-244-9977
Practice Address - Street 1:16010 PARK VALLEY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3574
Practice Address - Country:US
Practice Address - Phone:512-244-9944
Practice Address - Fax:512-244-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2043207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0078GNOtherBCBS
DE3953OtherRR MEDICARE
TX00607RMedicare PIN