Provider Demographics
NPI:1326604562
Name:PREMIER CARDIOLOGY CLINIC,PLLC
Entity Type:Organization
Organization Name:PREMIER CARDIOLOGY CLINIC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-854-2627
Mailing Address - Street 1:16969 N TEXAS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4094
Mailing Address - Country:US
Mailing Address - Phone:281-694-4555
Mailing Address - Fax:281-694-5595
Practice Address - Street 1:16969 N TEXAS AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4094
Practice Address - Country:US
Practice Address - Phone:281-694-4555
Practice Address - Fax:281-694-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty