Healthcare Provider Details

I. General information

NPI: 1578854436
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALISTS OF TEXAS, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 GOLDER AVE SUITE B
ODESSA TX
79761-5043
US

IV. Provider business mailing address

7215 WYOMING SPGS BUILDING 1, SUITE 100
ROUND ROCK TX
78681-4312
US

V. Phone/Fax

Practice location:
  • Phone: 512-807-3160
  • Fax:
Mailing address:
  • Phone: 512-807-3160
  • Fax: 512-494-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK CHUTICH
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 512-615-6224