Healthcare Provider Details

I. General information

NPI: 1447721402
Provider Name (Legal Business Name): CARDIOTHORACIC AND VASCULAR CONSULTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W ROSEDALE ST
FORT WORTH TX
76104-4681
US

IV. Provider business mailing address

900 W ROSEDALE ST
FORT WORTH TX
76104-4681
US

V. Phone/Fax

Practice location:
  • Phone: 817-885-7442
  • Fax: 817-885-7443
Mailing address:
  • Phone: 817-885-7442
  • Fax: 817-885-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES EDWARD ANDERSON JR.
Title or Position: PHYSICIAN
Credential: MD
Phone: 817-885-7442