MEDICARE: MEDICAL PLAZA CARDIOLOGY

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1598186223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL PLAZA CARDIOLOGY

Provider Business Mailing Address
First Line	:	2015 MULBERRY AVE
Second Line	:	SUITE 310
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2312
Country	:	US
Telephone Number	:	903-577-7070
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 MULBERRY AVE
Second Line	:	SUITE 310
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2312
Country	:	US
Telephone Number	:	903-577-7070
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR OF EMP PHY SER
Name	:	ELIZABETH RENAE THOMAS
Credential	:
Telephone Number	:	903-577-6555

Provider Enumeration Date	:	12/24/2013
Last Update Date	:	12/24/2013

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Directions to “MEDICAL PLAZA CARDIOLOGY ” Practice Location

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