Healthcare Provider Details

I. General information

NPI: 1760610042
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS OF TEXAS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND BLDG, 2, STE. 300
AUSTIN TX
78758-5386
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 512-807-3160
  • Fax: 512-615-0459
Mailing address:
  • Phone: 512-807-3180
  • 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: MARK N CHUTICH
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 512-615-6224