1467543835 NPI number — KPS CARDIOVASCULAR SURGERY PA

Table of content: (NPI 1467543835)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467543835 NPI number — KPS CARDIOVASCULAR SURGERY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KPS CARDIOVASCULAR SURGERY PA
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:
1467543835
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 SHENANDOAH DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SHENANDOAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77381-1204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-583-4000
Provider Business Mailing Address Fax Number:
281-580-5079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 SHENANDOAH DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77381-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-583-4000
Provider Business Practice Location Address Fax Number:
281-580-5079
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KITTEN
Authorized Official First Name:
CLIFFORD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-583-4000

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 095021403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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