Provider Demographics
NPI:1043426075
Name:HOUSTON HEART CLINIC
Entity Type:Organization
Organization Name:HOUSTON HEART CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IMTIHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAWDAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-759-9901
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:STE. 1590
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-759-9901
Mailing Address - Fax:281-540-3333
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:STE. 1590
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-759-9901
Practice Address - Fax:281-540-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9602174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080242301Medicaid
TXG9602OtherSTATE LICENSE
TX080242301Medicaid
TXB23739Medicare UPIN