1386632115 NPI number — CLINIC FOR CARDIOVASCULAR CARE

Table of content: (NPI 1386632115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386632115 NPI number — CLINIC FOR CARDIOVASCULAR CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINIC FOR CARDIOVASCULAR CARE
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:
LONE STAR HEART AND VASCULAR CENTER
Provider Other Organization Name Type Code:
3
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:
1386632115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 HOLDERRIETH BLVD
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
TOMBALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77375-4552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-255-2000
Provider Business Mailing Address Fax Number:
281-378-5918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 HOLDERRIETH BLVD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
TOMBALL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77375-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-251-2000
Provider Business Practice Location Address Fax Number:
281-378-5918
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
WAQAR
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
281-255-2000

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: DC4545 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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