Provider Demographics
NPI:1801555784
Name:360 CARDIAC CARE PC
Entity type:Organization
Organization Name:360 CARDIAC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAYANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMAKURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-334-7534
Mailing Address - Street 1:517 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-3719
Mailing Address - Country:US
Mailing Address - Phone:917-334-7534
Mailing Address - Fax:
Practice Address - Street 1:4375 BOOTH CALLOWAY RD STE 210
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8362
Practice Address - Country:US
Practice Address - Phone:817-678-5988
Practice Address - Fax:817-693-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty