MEDICARE: CENTRAL TEXAS CARDIOVASCULAR

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	174400000X	Specialist

General Provider Information

NPI Number	:	1811900848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL TEXAS CARDIOVASCULAR

Provider Business Mailing Address
First Line	:	7125 NEW SANGER RD
Second Line	:	SUITE D
City	:	WACO
State	:	TX
Zip	:	76712-4053
Country	:	US
Telephone Number	:	254-741-6333
Fax Number	:	254-741-6364

Provider Business Practice Location Address
First Line	:	7125 NEW SANGER RD
Second Line	:	SUITE D
City	:	WACO
State	:	TX
Zip	:	76712-4053
Country	:	US
Telephone Number	:	254-741-6333
Fax Number	:	254-741-6364

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. D. JEFFREY YOUNG
Credential	:	M.D.
Telephone Number	:	254-741-6333

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/22/2020

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