=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285013821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARIS CARDIOLOGY CENTER CATH LAB P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2015
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2620 SPUR 139
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-517-5431
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2620 SPUR 139
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-517-5431
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MRS. AYESHA SHAFIQ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-517-5431
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 130239
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------