Healthcare Provider Details

I. General information

NPI: 1366775942
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS OF TEXAS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4316 JAMES CASEY BUILDING C
AUSTIN TX
78745-1157
US

IV. Provider business mailing address

5301 RIATA PARK COURT BLDG. D, SUITE 200
AUSTIN TX
78727-3438
US

V. Phone/Fax

Practice location:
  • Phone: 512-617-6000
  • Fax: 512-494-1990
Mailing address:
  • Phone: 512-617-6000
  • Fax:

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: MARK N CHUTICH
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 512-615-6224