Provider Demographics
NPI:1255982344
Name:ELBASH HEART AND VASCULAR INSTITUTE OF TEXAS PLLC
Entity type:Organization
Organization Name:ELBASH HEART AND VASCULAR INSTITUTE OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:SALAH
Authorized Official - Last Name:ELBASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-612-0708
Mailing Address - Street 1:9742 AUTUMN CYN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-2419
Mailing Address - Country:US
Mailing Address - Phone:210-612-0708
Mailing Address - Fax:
Practice Address - Street 1:900 OBLATE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7332
Practice Address - Country:US
Practice Address - Phone:210-612-0708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR0564OtherMD LICENSE