=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265088207
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARIS CARDIOLOGY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2019
-----------------------------------------------------
Last Update Date | 06/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2675 41ST ST SE STE 103
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75462-8209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-609-4201
-----------------------------------------------------
Fax | 903-385-3500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 151 BETHANY DR
-----------------------------------------------------
City | MANHATTAN
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66503-3085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-850-3625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APRN
-----------------------------------------------------
Name | SUSAN KATHRYN MCCLINTOCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 612-850-3625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------