Healthcare Provider Details

I. General information

NPI: 1336118249
Provider Name (Legal Business Name): CAPITAL CARDIOVASCULAR CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 JAMES CASEY ST STE 215
AUSTIN TX
78745-3300
US

IV. Provider business mailing address

4207 JAMES CASEY ST STE 215
AUSTIN TX
78745-3300
US

V. Phone/Fax

Practice location:
  • Phone: 512-445-5998
  • Fax: 512-445-6095
Mailing address:
  • Phone: 512-445-5998
  • Fax: 512-445-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE D NACK
Title or Position: MEDICAL STAFF COORDINATOR
Credential: CPCS
Phone: 512-334-7855