1902820491 NPI number — PREMIER HEART SPECIALISTS P A

Table of content: (NPI 1902820491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902820491 NPI number — PREMIER HEART SPECIALISTS P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER HEART SPECIALISTS P A
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:
1902820491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4102 WOODLAWN
Provider Second Line Business Mailing Address:
#110
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-946-6081
Provider Business Mailing Address Fax Number:
713-946-6086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4102 WOODLAWN
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-946-6081
Provider Business Practice Location Address Fax Number:
713-946-6086
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALAKRISHNAN
Authorized Official First Name:
PALUR
Authorized Official Middle Name:
V
Authorized Official Title or Position:
MEDICAL DOCTOR OWNER
Authorized Official Telephone Number:
713-946-6081

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  F5827 , 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: 085778101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0037DM . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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