Provider Demographics
NPI:1023221876
Name:HOUSTON CARDIAC ASSOCIATION, PA
Entity Type:Organization
Organization Name:HOUSTON CARDIAC ASSOCIATION, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BAXTER
Authorized Official - Middle Name:DELWORTH
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-599-1144
Mailing Address - Street 1:10480 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5500
Mailing Address - Country:US
Mailing Address - Phone:713-599-1144
Mailing Address - Fax:713-599-1199
Practice Address - Street 1:10480 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5500
Practice Address - Country:US
Practice Address - Phone:713-599-1144
Practice Address - Fax:713-599-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9549207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5034595OtherAETNA
TX10018324OtherAMERIGROUP
TX081027701Medicaid
TX132190301Medicaid
TX85680FOtherBCBS OF TEXAS
TXF87839Medicare UPIN
TX081027701Medicaid
TX060052268Medicare PIN
TX132190301Medicaid
TX85680FOtherBCBS OF TEXAS
TX060052268Medicare ID - Type UnspecifiedRAILROAD MEDICARE