Provider Demographics
NPI:1215486691
Name:WICHITA FALLS HEART CLINIC PLLC
Entity type:Organization
Organization Name:WICHITA FALLS HEART CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-687-5000
Mailing Address - Street 1:2101 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4133
Mailing Address - Country:US
Mailing Address - Phone:940-766-3190
Mailing Address - Fax:940-687-1617
Practice Address - Street 1:2101 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4133
Practice Address - Country:US
Practice Address - Phone:940-766-3190
Practice Address - Fax:940-687-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty