Healthcare Provider Details

I. General information

NPI: 1811295892
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2011
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 LONGHORN PKWY
AUSTIN TX
78732-1267
US

IV. Provider business mailing address

7215 WYOMING SPGS BLDG. 1 STE. 100
ROUND ROCK TX
78681-4312
US

V. Phone/Fax

Practice location:
  • Phone: 512-266-5600
  • Fax: 512-266-5601
Mailing address:
  • Phone: 512-807-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK N, CHUTICH
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 512-615-6224