Healthcare Provider Details

I. General information

NPI: 1609804301
Provider Name (Legal Business Name): TEXAS CARDIOVASCULAR CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 512-617-6000
  • Fax: 512-615-0459
Mailing address:
  • Phone: 512-617-6000
  • Fax: 512-615-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY TYPHAIR
Title or Position: DIRECTOR, BUSINESS SERVICES
Credential:
Phone: 512-615-6218