Basic Information
| Provider Information | |||||||||
| NPI: | 1174759344 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BT HEART AND VASCULAR CENTER, PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE HEART AND VASCULAR CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 65053 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282650053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367197892 | ||||||||
| FaxNumber: | 3367196870 | ||||||||
| Practice Location | |||||||||
| Address1: | 124 SAMARITANS RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | ELKIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286212452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367197892 | ||||||||
| FaxNumber: | 3367196870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2009 | ||||||||
| LastUpdateDate: | 06/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | BOWMAN | ||||||||
| AuthorizedOfficialFirstName: | LESA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3367197892 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.