Healthcare Provider Details

I. General information

NPI: 1114996006
Provider Name (Legal Business Name): CARDIAC CONSULTANTS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 PLAZA 10 DR. STE E.
BEAUMONT TX
77707-2553
US

IV. Provider business mailing address

3345 PLAZA 10 DR. STE
BEAUMONT TX
77707-2553
US

V. Phone/Fax

Practice location:
  • Phone: 409-838-2626
  • Fax: 409-838-1980
Mailing address:
  • Phone: 409-838-2626
  • Fax: 409-838-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RAHUL PATRI
Title or Position: VP
Credential: MD
Phone: 409-838-2626