Provider Demographics
NPI:1245233501
Name:PHYSICIANS CARDIOVASCULAR DIAGNOSTIC CENTER, L.L.P.
Entity Type:Organization
Organization Name:PHYSICIANS CARDIOVASCULAR DIAGNOSTIC CENTER, L.L.P.
Other - Org Name:CARDIOVASCULAR DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:RANDOLPH
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-924-3996
Mailing Address - Street 1:2955 HARRISON ST
Mailing Address - Street 2:STE 300
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1157
Mailing Address - Country:US
Mailing Address - Phone:409-924-3996
Mailing Address - Fax:409-924-3916
Practice Address - Street 1:2955 HARRISON ST
Practice Address - Street 2:STE 300
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1157
Practice Address - Country:US
Practice Address - Phone:409-924-3996
Practice Address - Fax:409-924-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR25618261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH1821OtherBLUECROSS BLUESHIELD PROV
TX470001866OtherMEDICARE RAILROAD PROVIDE
TX155417201Medicaid
TXFTK024Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER