MEDICARE: SOUTHWEST CARDIOVASCULAR INTERVENTION CLINIC, 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	261Q00000X	Clinic/Center
2	207RI0011X	Interventional Cardiology Physician	M9797	TX

General Provider Information

NPI Number	:	1457517617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST CARDIOVASCULAR INTERVENTION CLINIC, PA

Provider Business Mailing Address
First Line	:	1508 N ZARAGOZA RD STE ABCD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8034
Country	:	US
Telephone Number	:	915-298-5425
Fax Number	:	915-298-5430

Provider Business Practice Location Address
First Line	:	1508 N ZARAGOZA RD STE ABCD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8034
Country	:	US
Telephone Number	:	915-298-5425
Fax Number	:	915-298-5430

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHIKEZIE CHIDIEBERE AMADI
Credential	:	M.D.
Telephone Number	:	915-373-9066

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	11/09/2022

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