Healthcare Provider Details

I. General information

NPI: 1285013821
Provider Name (Legal Business Name): PARIS CARDIOLOGY CENTER CATH LAB P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 SPUR 139
PARIS TX
75462
US

IV. Provider business mailing address

2620 SPUR 139
PARIS TX
75462
US

V. Phone/Fax

Practice location:
  • Phone: 903-517-5431
  • Fax:
Mailing address:
  • Phone: 903-517-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number130239
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateTX

VIII. Authorized Official

Name: MRS. AYESHA SHAFIQ
Title or Position: DIRECTOR
Credential:
Phone: 903-517-5431