Provider Demographics
NPI:1144218777
Name:TOTAL HEART CARDIOVASCULAR CONSULTANTS LLC
Entity Type:Organization
Organization Name:TOTAL HEART CARDIOVASCULAR CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ESE
Authorized Official - Last Name:OTAH
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD MSC FACC
Authorized Official - Phone:281-232-3886
Mailing Address - Street 1:138 ELDRIDGE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4083
Mailing Address - Country:US
Mailing Address - Phone:281-232-3886
Mailing Address - Fax:281-232-3986
Practice Address - Street 1:138 ELDRIDGE RD
Practice Address - Street 2:SUITE E
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4083
Practice Address - Country:US
Practice Address - Phone:281-232-3886
Practice Address - Fax:281-232-3986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7835207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1754517Medicaid
TX1754517Medicaid
00479YMedicare PIN