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General NPI Number Information
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NPI Number | 1114311826
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Entity Type | Organization
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Legal Business Name | TEXAS CARDIOVASCULAR
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 2123 S CLEAR CREEK RD
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City | KILLEEN
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State | TX
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Zip | 76549-4110
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Country | US
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Telephone | 254-526-9766
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Fax | 254-634-7700
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Provider Business Mailing Address
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Address Line | 2123 S CLEAR CREEK RD
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City | KILLEEN
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State | TX
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Zip | 76549-4110
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Country | US
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Telephone | 254-526-9766
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Fax | 254-634-7700
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Authorized Official
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Title or Position | CARDIOLOGIST
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Name | DR. GEORGE S REBECCA
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Credential | MD
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Telephone | 254-526-9766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | J3883
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License Number State | TX
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