MEDICARE: CARDIAC CIN OF NORTH 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
1	207RI0011X	Interventional Cardiology Physician		TX
2	207RC0000X	Cardiovascular Disease Physician		TX

General Provider Information

NPI Number	:	1346758695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC CIN OF NORTH TEXAS

Provider Business Mailing Address
First Line	:	102 WOODMONT BLVD STE 350
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37205-2216
Country	:	US
Telephone Number	:	615-386-0064
Fax Number	:	615-386-0067

Provider Business Practice Location Address
First Line	:	6565 N MACARTHUR BLVD STE 225C
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2490
Country	:	US
Telephone Number	:	615-386-0064
Fax Number	:	615-386-0067

Authorized Official
Title or Position	:	DIRECTOR
Name	:	EDWARD LELAND HUTTON EADIE
Credential	:
Telephone Number	:	615-733-2064

Provider Enumeration Date	:	01/19/2018
Last Update Date	:	02/13/2020

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Directions to “CARDIAC CIN OF NORTH TEXAS ” Practice Location

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