MEDICARE: TEXAS CARDIOVASCULAR CONSULTANTS, PA

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
1	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1174778625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS CARDIOVASCULAR CONSULTANTS, PA

Provider Business Mailing Address
First Line	:	5301 RIATA PARK CT
Second Line	:	BLDG D, SUITE 200
City	:	AUSTIN
State	:	TX
Zip	:	78727-3438
Country	:	US
Telephone Number	:	512-615-6218
Fax Number	:

Provider Business Practice Location Address
First Line	:	11111 RESEARCH BLVD
Second Line	:	SUITE 360
City	:	AUSTIN
State	:	TX
Zip	:	78759-5248
Country	:	US
Telephone Number	:	512-617-6000
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, BUSINESS SERVICES
Name	:	MARY TYPHAIR
Credential	:
Telephone Number	:	512-615-6218

Provider Enumeration Date	:	11/25/2008
Last Update Date	:	03/24/2009

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