Healthcare Provider Details

I. General information

NPI: 1639599269
Provider Name (Legal Business Name): AMARILLO HEART CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 PORT LN
AMARILLO TX
79106-2430
US

IV. Provider business mailing address

1901 PORT LN
AMARILLO TX
79106-2430
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-4714
  • Fax: 806-468-0283
Mailing address:
  • Phone: 806-358-4596
  • Fax: 806-358-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERRI MARTINEZ
Title or Position: C.E.O.
Credential:
Phone: 806-358-4596