1588877385 NPI number — COLLIN COUNTY CARDIOLOGY, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588877385 NPI number — COLLIN COUNTY CARDIOLOGY, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLIN COUNTY CARDIOLOGY, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588877385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 W 15TH ST
Provider Second Line Business Mailing Address:
SUITE 503
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-4727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-773-6488
Provider Business Mailing Address Fax Number:
972-596-8976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 W 15TH ST
Provider Second Line Business Practice Location Address:
SUITE 503
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-773-6488
Provider Business Practice Location Address Fax Number:
972-596-8976
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LANKIPALLI
Authorized Official First Name:
RAMARAO
Authorized Official Middle Name:
SUBBARAMA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-773-6488

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  M1865 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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