Basic Information
| Provider Information | |||||||||
| NPI: | 1205810991 | ||||||||
| 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: | 223 HOSPITAL ST | ||||||||
| Address2: | |||||||||
| City: | MOCKSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270282038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367652500 | ||||||||
| FaxNumber: | 3367652555 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 HOSPITAL ST | ||||||||
| Address2: | |||||||||
| City: | MOCKSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270282038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367652500 | ||||||||
| FaxNumber: | 3367652555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | TAGHIZADEH | ||||||||
| AuthorizedOfficialFirstName: | BEHZAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3367652500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 124240 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | DC6367 | 01 | NC | MEDICARE RR | OTHER | 116217 | 01 | NC | AETNA | OTHER | 5900341 | 05 | NC | MEDICAID | DC6368 | 01 | VA | MEDICARE RR | OTHER |