Provider Demographics
NPI:1164671541
Name:HADIDI HEART & VASCULAR MD PA
Entity Type:Organization
Organization Name:HADIDI HEART & VASCULAR MD PA
Other - Org Name:BAYTOWN IMAGING CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYEZ
Authorized Official - Middle Name:H
Authorized Official - Last Name:HADIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-422-3364
Mailing Address - Street 1:4301 GARTH RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:281-422-3364
Mailing Address - Fax:281-422-6864
Practice Address - Street 1:4301 GARTH RD STE 101
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:281-422-3364
Practice Address - Fax:281-422-6864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8673261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A6288Medicare UPIN