Healthcare Provider Details

I. General information

NPI: 1215178967
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS OF TEXAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W 38TH ST SUITE 705
AUSTIN TX
78705-1016
US

IV. Provider business mailing address

7215 WYOMING SPRINGS DR. BLDG. 1, STE. 100
ROND ROCK TX
78681-4311
US

V. Phone/Fax

Practice location:
  • Phone: 512-807-3160
  • Fax: 512-615-0459
Mailing address:
  • Phone: 512-615-6224
  • Fax: 512-615-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology 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