Healthcare Provider Details

I. General information

NPI: 1194736314
Provider Name (Legal Business Name): CARDIOVASCULARSPECIALTY ASSOCIATES OF NORTH TEXAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 GREENWAY DRIVE SUITE 200
IRVING TX
75038-2503
US

IV. Provider business mailing address

1320 GREENWAY DRIVE SUITE 200
IRVING TX
75038-2503
US

V. Phone/Fax

Practice location:
  • Phone: 972-550-9195
  • Fax: 972-550-9279
Mailing address:
  • Phone: 972-550-9195
  • Fax: 972-550-9279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberF3815
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberF3815
License Number StateTX

VIII. Authorized Official

Name: DAVID J. CARTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 972-550-9195