1639620529 NPI number — SAM HOUSTON HEART AND VASCULAR CENTER PLLC

Table of content: (NPI 1639620529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639620529 NPI number — SAM HOUSTON HEART AND VASCULAR CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAM HOUSTON HEART AND VASCULAR CENTER PLLC
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:
BASHIR AL-KADDOUMI, MD,PA
Provider Other Organization Name Type Code:
5
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:
1639620529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10618 BLITHE OAK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMBALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77375-0136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-502-0026
Provider Business Mailing Address Fax Number:
281-547-7464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18220 STATE HIGHWAY 249
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77070-4347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-241-2001
Provider Business Practice Location Address Fax Number:
281-547-7464
Provider Enumeration Date:
10/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MENDEZ
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
832-241-2001

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  P1959 , 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: 365724901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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