Provider Demographics
NPI:1144403650
Name:EP-CARDIOLOGY PA
Entity Type:Organization
Organization Name:EP-CARDIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-799-1610
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 1723
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-799-1610
Mailing Address - Fax:713-799-1558
Practice Address - Street 1:500 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2889
Practice Address - Country:US
Practice Address - Phone:936-441-3232
Practice Address - Fax:936-756-3235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EP/CARDIOLOGY PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-07
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CH7910OtherMEDICARE RR
TX00438ROtherBLUE SHIELD
CH7910OtherMEDICARE RR