Organization
CENTRAL TEXAS HEART CENTER
Active
Other names
Prof Association
Organization subpart
No
Provider details
NPI number
Authorized official
KENNON D WIGLEY MD (PHYSICIAN)
(979) 774-4008
Entity
Organization
Contact information
Practice address
2700 E 29TH STREET, SUITE 220, BRYAN, TX 77802-2586
(979) 774-4008
(979) 774-7893
Mailing address
2700 E 29TH ST, SUITE 220, BRYAN, TX 77802-2531
(979) 774-4008
(979) 774-7893
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
082010201
—
TX
01
—
CD6802
RAILROAD MEDICARE
—
Enumeration date
11/16/2006
Last updated
04/25/2013
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