Healthcare Provider Details

I. General information

NPI: 1194054023
Provider Name (Legal Business Name): TEXAS CARDIOVASCULAR CONSULTANTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 E. WHITESTONE BLVD. SUITE 230
CEDAR PARK TX
78613-2274
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:
Mailing address:
  • Phone: 512-617-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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