Provider Demographics
NPI:1376604785
Name:NON-INVASIVE CARDIOVASCULAR PA
Entity Type:Organization
Organization Name:NON-INVASIVE CARDIOVASCULAR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLOVER
Authorized Official - Middle Name:OL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:713-234-7390
Mailing Address - Street 1:10906 OLYMPIA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2629
Mailing Address - Country:US
Mailing Address - Phone:713-234-7390
Mailing Address - Fax:713-234-7336
Practice Address - Street 1:138 ELDRIDGE RD
Practice Address - Street 2:STE E
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4083
Practice Address - Country:US
Practice Address - Phone:713-234-7390
Practice Address - Fax:713-234-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE2031207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDA1201OtherMEDICARE RAILROAD
TX01209859OtherAMERIGROUP
TX167319601Medicaid
TX0064KBOtherBCBS GROUP
TX2354224OtherAETNA
TX00171VMedicare PIN