Provider Demographics
NPI:1982784195
Name:TEXAS HEART CLINIC PA
Entity Type:Organization
Organization Name:TEXAS HEART CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDERHORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-922-9050
Mailing Address - Street 1:PO BOX 12229
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-8229
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1307 8TH AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104
Practice Address - Country:US
Practice Address - Phone:817-922-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
TXJ2843207RC0000X, 207RC0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2500101OtherUNITED HEALTHCARE
TX2837065012OtherCIGNA HMO
TX168218901Medicaid
TX4236959OtherAETNA PPO
TX2171076OtherAETNA HMO
TX60055861OtherMEDICARE RAILROAD
TX0071DUOtherBCBS OF TEXAS GROUP #
TX2837065007OtherCIGNA PPO
TX=========OtherTRICARE SOUTH
E51105Medicare UPIN
TX00187XMedicare PIN