MEDICARE: MEDICAL & HEART CENTER 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	G2824	TX

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	:	1629171186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL & HEART CENTER PA

Provider Business Mailing Address
First Line	:	2614 E BANKHEAD HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-9558
Country	:	US
Telephone Number	:	817-341-8646
Fax Number	:	817-341-1905

Provider Business Practice Location Address
First Line	:	2614 E BANKHEAD HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-9558
Country	:	US
Telephone Number	:	817-341-8646
Fax Number	:	817-341-1905

Authorized Official
Title or Position	:	OWNER
Name	:	GUDURU R REDDY
Credential	:	MD
Telephone Number	:	817-341-8646

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	09/21/2009

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Directions to “MEDICAL & HEART CENTER PA ” Practice Location

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