Healthcare Provider Details

I. General information

NPI: 1164734059
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 CR 340-A BLDG. 4, STE. A
BURNET TX
78611
US

IV. Provider business mailing address

7000 N MOPAC EXPY SECOND FLOOR
AUSTIN TX
78731-3027
US

V. Phone/Fax

Practice location:
  • Phone: 512-756-0900
  • Fax: 512-756-0905
Mailing address:
  • Phone: 512-615-6200
  • Fax:

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 Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK CHUTICH
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 512-615-6224