1659078632 NPI number — HENRY LEROY BURKHOLDER IV MD, PLLC

Table of content: (NPI 1659078632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659078632 NPI number — HENRY LEROY BURKHOLDER IV MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENRY LEROY BURKHOLDER IV MD, 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:
CATCH CARDIOLOGY
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:
1659078632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13100 WORTHAM CENTER DR FL 3
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:
77065-5625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-737-5912
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17450 ST LUKES WAY STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77384-8045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-843-8441
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TATE
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
VP BUSINESS OPERATIONS
Authorized Official Telephone Number:
713-737-5912

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: N7062 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1134474380 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 332420 . This is a "MD LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: DR.0067463 . This is a "MD LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".