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NPI Code Detail

MEDICARE: CARDIAC SURGICAL ASSOCIATES OF WEST TEXAS

MEDICARE: CARDIAC SURGICAL ASSOCIATES OF WEST TEXAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistF3628TX

General Provider Information

NPI Number : 1093938631
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARDIAC SURGICAL ASSOCIATES OF WEST TEXAS
Provider Business Mailing Address
First Line : 710 E 6TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-4655
Country : US
Telephone Number : 432-332-4044
Fax Number : 432-332-4048
Provider Business Practice Location Address
First Line : 710 E 6TH ST
Second Line :
City : ODESSA
State : TX
Zip : 79761-4655
Country : US
Telephone Number : 432-332-4044
Fax Number : 432-332-4048
Authorized Official
Title or Position : PHYSCIAN
Name : SUDHIR P SRIVASTAVA
Credential : MD
Telephone Number : 432-332-4044
Provider Enumeration Date : 04/11/2007
Last Update Date : 08/22/2020

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Directions to “CARDIAC SURGICAL ASSOCIATES OF WEST TEXAS ” Practice Location

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