Provider Demographics
NPI:1467534529
Name:MEDICAL CENTER CATH LAB, LLP
Entity Type:Organization
Organization Name:MEDICAL CENTER CATH LAB, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-790-0841
Mailing Address - Street 1:6400 FANNIN
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1511
Mailing Address - Country:US
Mailing Address - Phone:713-790-0841
Mailing Address - Fax:713-790-1350
Practice Address - Street 1:6550 FANNIN
Practice Address - Street 2:SUITE 333
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2718
Practice Address - Country:US
Practice Address - Phone:713-790-5721
Practice Address - Fax:713-790-5769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115263902Medicaid
TXHH1810OtherBLUE CROSS BLUE SHIELD
TX690007448OtherRAILROAD MEDICARE
TXHH1810OtherBLUE CROSS BLUE SHIELD
TX690007448OtherRAILROAD MEDICARE