1558565705 NPI number — PREMIER CARDIOVASCULAR CONSULTANTS PC

Table of content: (NPI 1558565705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558565705 NPI number — PREMIER CARDIOVASCULAR CONSULTANTS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER CARDIOVASCULAR CONSULTANTS PC
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:
1558565705
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 N WASHINGTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77327-3732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-593-3389
Provider Business Mailing Address Fax Number:
281-592-0479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 E HOUSTON ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77327-4602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-593-3389
Provider Business Practice Location Address Fax Number:
281-592-0479
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AHMAD
Authorized Official First Name:
NABIL
Authorized Official Middle Name:
MAHMOOD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-593-2899

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  L0739 , 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: 194264101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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