Provider Demographics
NPI:1730115114
Name:HEART & VASCULAR CENTER PLLC
Entity type:Organization
Organization Name:HEART & VASCULAR CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-250-4278
Mailing Address - Street 1:3106 NW ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6123
Mailing Address - Country:US
Mailing Address - Phone:580-250-4278
Mailing Address - Fax:
Practice Address - Street 1:3106 NW ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6123
Practice Address - Country:US
Practice Address - Phone:580-250-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK20069590AMedicaid
OK800522483Medicare ID - Type Unspecified