Provider Demographics
NPI:1114943586
Name:REDOAK CARDIOVASCULAR CENTER, PA
Entity Type:Organization
Organization Name:REDOAK CARDIOVASCULAR CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-534-7122
Mailing Address - Street 1:17400 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1246
Mailing Address - Country:US
Mailing Address - Phone:281-893-8640
Mailing Address - Fax:281-893-5976
Practice Address - Street 1:17400 RED OAK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1246
Practice Address - Country:US
Practice Address - Phone:281-893-8640
Practice Address - Fax:281-893-5976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127354201Medicaid