Healthcare Provider Details

I. General information

NPI: 1447212303
Provider Name (Legal Business Name): CARDIOVASCULAR ASSOCIATES OF EAST TEXAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1783 TROUP HWY
TYLER TX
75701-5869
US

IV. Provider business mailing address

1783 TROUP HWY
TYLER TX
75701-5869
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-2283
  • Fax: 903-595-1063
Mailing address:
  • Phone: 903-595-2283
  • Fax: 903-595-1063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBBIE KIRKPATRICK
Title or Position: SUPPORT SUPERVISOR
Credential:
Phone: 903-595-2283