1144403650 NPI number — EP-CARDIOLOGY PA

Table of content: (NPI 1144403650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144403650 NPI number — EP-CARDIOLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EP-CARDIOLOGY PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144403650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6550 FANNIN ST
Provider Second Line Business Mailing Address:
SUITE 1723
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-799-1610
Provider Business Mailing Address Fax Number:
713-799-1558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77304-2889
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-441-3232
Provider Business Practice Location Address Fax Number:
936-756-3235
Provider Enumeration Date:
12/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEVITT
Authorized Official First Name:
JO ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
713-799-1610

Provider Taxonomy Codes

  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH7910 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00438R . This is a "BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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