MEDICARE: LONE STAR CARDIOVASCULAR INSTITUTE, P.L.L.C

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	:	1194550178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR CARDIOVASCULAR INSTITUTE, P.L.L.C

Provider Business Mailing Address
First Line	:	4900 BOAT CLUB RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-1802
Country	:	US
Telephone Number	:	682-224-9061
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 BOAT CLUB RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-1802
Country	:	US
Telephone Number	:	682-224-9061
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	GEORGE JAMES
Credential	:	MD
Telephone Number	:	682-224-9061

Provider Enumeration Date	:	09/07/2024
Last Update Date	:	09/09/2024

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