1245233501 NPI number — PHYSICIANS CARDIOVASCULAR DIAGNOSTIC CENTER, L.L.P.

Table of content: (NPI 1245233501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245233501 NPI number — PHYSICIANS CARDIOVASCULAR DIAGNOSTIC CENTER, L.L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS CARDIOVASCULAR DIAGNOSTIC CENTER, L.L.P.
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:
6
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:
1245233501
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2955 HARRISON ST
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77702-1157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-924-3996
Provider Business Mailing Address Fax Number:
409-924-3916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2955 HARRISON ST
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77702-1157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-924-3996
Provider Business Practice Location Address Fax Number:
409-924-3916
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LOMBARDO
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
RANDOLPH
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
409-924-3996

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  R25618 , 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: HH1821 . This is a "BLUECROSS BLUESHIELD PROV" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 470001866 . This is a "MEDICARE RAILROAD PROVIDE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 155417201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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