1548301252 NPI number — ACRES HOME HEART AND VASCULAR INSTITUTE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548301252 NPI number — ACRES HOME HEART AND VASCULAR INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACRES HOME HEART AND VASCULAR INSTITUTE
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:
1548301252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77001-0302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-445-5900
Provider Business Mailing Address Fax Number:
281-445-5903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9999 W MONTGOMERY RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77088-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-445-5900
Provider Business Practice Location Address Fax Number:
281-445-5903
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RUGGLES
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
281-445-5900

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  M0502 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1824302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0022NV . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1824286 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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