MEDICARE: EXCEL CARDIAC CARE PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RI0011X	Interventional Cardiology Physician
2	246W00000X	Cardiology Technician
3	246X00000X	Cardiovascular Specialist/Technologist
4	246XC2901X	Cardiovascular Invasive Specialist/Technologist
5	246XC2903X	Vascular Specialist/Technologist Cardiovascular
6	246XS1301X	Sonography Specialist/Technologist Cardiovascular
7	261QM2500X	Medical Specialty Clinic/Center
8	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578904512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL CARDIAC CARE PLLC

Provider Business Mailing Address
First Line	:	4400 HERITAGE TRACE PKWY STE 208
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8902
Country	:	US
Telephone Number	:	817-518-9005
Fax Number	:	817-518-9015

Provider Business Practice Location Address
First Line	:	4400 HERITAGE TRACE PKWY STE 208
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8902
Country	:	US
Telephone Number	:	817-518-9005
Fax Number	:	817-518-9015

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. SARITHA DODLA
Credential	:	MD
Telephone Number	:	940-634-3035

Provider Enumeration Date	:	07/06/2013
Last Update Date	:	01/07/2023

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