Basic Information
| Provider Information | |||||||||
| NPI: | 1497739189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BT HEART AND VASCULAR CENTER, PLLC | ||||||||
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| OtherOrganizationName: | THE HEART AND VASCULAR CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 CHARLOIS BLVD | ||||||||
| Address2: | SUITE 223 | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271031549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367652500 | ||||||||
| FaxNumber: | 3367652555 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 CHARLOIS BLVD | ||||||||
| Address2: | SUITE 223 | ||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271031549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367652500 | ||||||||
| FaxNumber: | 3367652555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 10/22/2007 | ||||||||
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| AuthorizedOfficialLastName: | TAGHIZADEH | ||||||||
| AuthorizedOfficialFirstName: | BEHZAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3367652500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 | 1528049269 | 01 | PAULA CARTER | OTHER | 1750362430 | 01 | DR. KENNETH RHINEHART | OTHER | 1003888066 | 01 | NC | THEODORE KEITH, JR., MD | OTHER | 1275514986 | 01 | DR. BEHZAD TAGHIZADEH | OTHER | 1386843498 | 01 | NC | AMY SPETZ, PA | OTHER | 1538112529 | 01 | NC | TIFFANY SPEAS, PA | OTHER | DC6367 | 01 | NC | MEDICARE RR | OTHER | 5900341 | 05 | NC | MEDICAID | 1629037387 | 01 | NC | ALFRED RUFTY, JR., MD | OTHER | 0294L | 01 | NC | BCBS | OTHER | 1134191273 | 01 | NC | CHARLES W HARRIS, JR., MD | OTHER |