Provider Demographics
NPI:1013019157
Name:INTERVENTIONAL CARDIOLOGY
Entity Type:Organization
Organization Name:INTERVENTIONAL CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-829-3860
Mailing Address - Street 1:19255 PARK ROW STE 204
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7310
Mailing Address - Country:US
Mailing Address - Phone:281-829-3860
Mailing Address - Fax:281-829-3861
Practice Address - Street 1:19255 PARK ROW STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7310
Practice Address - Country:US
Practice Address - Phone:281-829-3860
Practice Address - Fax:281-829-3861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDF8541OtherMEDICARE B RR
TX0035NZOtherBCBS
TX184963001Medicaid
TX184963001Medicaid