Provider Demographics
NPI:1972245181
Name:HEART AND VASCULAR MEDICAL CENTER OF NORTH TEXAS PLLC
Entity type:Organization
Organization Name:HEART AND VASCULAR MEDICAL CENTER OF NORTH TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:AMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-423-9799
Mailing Address - Street 1:1289 BOURLAND RD
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3924
Mailing Address - Country:US
Mailing Address - Phone:714-423-9799
Mailing Address - Fax:714-242-3404
Practice Address - Street 1:171 W SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6306
Practice Address - Country:US
Practice Address - Phone:714-423-9799
Practice Address - Fax:714-242-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX817304OtherMEDICARE
TX400134901Medicaid