Provider Demographics
NPI:1467543835
Name:KPS CARDIOVASCULAR SURGERY PA
Entity Type:Organization
Organization Name:KPS CARDIOVASCULAR SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-583-4000
Mailing Address - Street 1:118 SHENANDOAH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1204
Mailing Address - Country:US
Mailing Address - Phone:281-583-4000
Mailing Address - Fax:281-580-5079
Practice Address - Street 1:118 SHENANDOAH DR
Practice Address - Street 2:SUITE A
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77381-1204
Practice Address - Country:US
Practice Address - Phone:281-583-4000
Practice Address - Fax:281-580-5079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208G00000X, 363AS0400X
TXH7834174400000X
TXK6486174400000X
TXPA03213363AS0400X
TXE4456174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095021403Medicaid
TXCT1687Medicare PIN
TX00R51ZMedicare PIN
TX4639395OtherAETNA PIN
TXS48148Medicare UPIN
TX095021401Medicaid
TXB23996Medicare UPIN
TX00R51ZMedicare PIN