MEDICARE: PULSE HEART AND VASCULAR PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	246W00000X	Cardiology Technician
2	246X00000X	Cardiovascular Specialist/Technologist
3	246XC2901X	Cardiovascular Invasive Specialist/Technologist
4	246XS1301X	Sonography Specialist/Technologist Cardiovascular
5	363L00000X	Nurse Practitioner
6	207R00000X	Internal Medicine Physician
7	207RI0011X	Interventional Cardiology Physician
8	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1720778293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULSE HEART AND VASCULAR 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	:	05/09/2023
Last Update Date	:	05/09/2023

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