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General NPI Number Information
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NPI Number | 1720221765
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Entity Type | Organization
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Legal Business Name | VALIANT CARDIOPULMONARY INDEPENDENT DIAGNOSTIC TESTING FACILITY
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 12/14/2012
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Provider Practice Location Address
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Address Line | 1010 W JASPER DR SUITE 11
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City | KILLEEN
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State | TX
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Zip | 76542-1331
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Country | US
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Telephone | 254-213-5425
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Fax | 254-616-9450
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Provider Business Mailing Address
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Address Line | 1010 W JASPER DR SUITE 11
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City | KILLEEN
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State | TX
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Zip | 76542-1331
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Country | US
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Telephone | 254-213-5425
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Fax | 254-616-9450
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BETTIE GENE HANKINS
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Credential | RRT-NPS, RPFT
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Telephone | 254-213-5425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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