1922491448 NPI number — PEDIATRIC CARDIOLOGY CARE PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922491448 NPI number — PEDIATRIC CARDIOLOGY CARE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC CARDIOLOGY CARE 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:
1922491448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 W BAY AREA BLVD
Provider Second Line Business Mailing Address:
SUITE 625
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77598-4043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-648-3000
Provider Business Mailing Address Fax Number:
281-648-3001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 W BAY AREA BLVD
Provider Second Line Business Practice Location Address:
SUITE 625
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77598-4043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-648-3000
Provider Business Practice Location Address Fax Number:
281-648-3001
Provider Enumeration Date:
03/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GOSPIN
Authorized Official First Name:
TAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-648-3000

Provider Taxonomy Codes

  • Taxonomy code: 2080P0202X , 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)





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