Provider Demographics
NPI:1043955404
Name:DFW CARDIOVASCULAR INSTITUTE PLLC
Entity type:Organization
Organization Name:DFW CARDIOVASCULAR INSTITUTE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MARENO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-417-1936
Mailing Address - Street 1:9901 VALLEY RANCH PKWY E STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4730
Mailing Address - Country:US
Mailing Address - Phone:985-713-1173
Mailing Address - Fax:
Practice Address - Street 1:9901 VALLEY RANCH PKWY E STE 101
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4730
Practice Address - Country:US
Practice Address - Phone:985-713-1173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-30
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty