1538124458 NPI number — MEMORIAL CITY CARDIOLOGY ASSOCIATES INC

Table of content: (NPI 1538124458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538124458 NPI number — MEMORIAL CITY CARDIOLOGY ASSOCIATES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEMORIAL CITY CARDIOLOGY ASSOCIATES INC
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:
MEMORIAL KATY CARDIOLOGY VEIN & 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:
1538124458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1331 W GRAND PKWY N STE 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77493-2711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-392-3401
Provider Business Mailing Address Fax Number:
281-392-7814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10496 KATY FWY STE 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-464-2928
Provider Business Practice Location Address Fax Number:
713-464-6560
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ODHAV
Authorized Official First Name:
ANIL
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
713-464-2928

Provider Taxonomy Codes

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

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

  • Identifier: 00R225 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 084702201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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