Healthcare Provider Details

I. General information

NPI: 1578904512
Provider Name (Legal Business Name): EXCEL CARDIAC CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2013
Last Update Date: 01/07/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 HERITAGE TRACE PKWY STE 208
FORT WORTH TX
76244-8902
US

IV. Provider business mailing address

4400 HERITAGE TRACE PKWY STE 208
FORT WORTH TX
76244-8902
US

V. Phone/Fax

Practice location:
  • Phone: 817-518-9005
  • Fax: 817-518-9015
Mailing address:
  • Phone: 817-518-9005
  • Fax: 817-518-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246X00000X
TaxonomyCardiovascular Specialist/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code246XC2903X
TaxonomyVascular Specialist/Technologist Cardiovascular
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARITHA DODLA
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 940-634-3035