MEDICARE: J. PHILLIP MYATT, M.D., PLLC DBA WACO HEART & VASCULAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	N1791	TX
2	207RC0000X	Cardiovascular Disease Physician	N1791	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	301250	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1255674586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J. PHILLIP MYATT, M.D., PLLC DBA WACO HEART & VASCULAR

Provider Business Mailing Address
First Line	:	321 RICHLAND WEST CIR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-7919
Country	:	US
Telephone Number	:	254-235-9355
Fax Number	:	254-235-2135

Provider Business Practice Location Address
First Line	:	321 RICHLAND WEST CIR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-7919
Country	:	US
Telephone Number	:	254-235-9355
Fax Number	:	254-235-2135

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES PHILLIP MYATT
Credential	:	MD
Telephone Number	:	254-235-9355

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	03/19/2026

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