=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669443669
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST CARDIAC ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2006
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4708 ALLIANCE BLVD SUITE 750
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-5340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-467-8222
-----------------------------------------------------
Fax | 972-867-5457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5308 NORTH GALLOWAY AVE SUITE 100
-----------------------------------------------------
City | MESQUITE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-226-0505
-----------------------------------------------------
Fax | 972-289-9640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BASIM M JISHI
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 972-226-0505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------