Provider Demographics
NPI:1508196254
Name:CARDIOVASCULAR HEALTH CENTER OF TEXAS LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR HEALTH CENTER OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. ASST.
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGGLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-445-5900
Mailing Address - Street 1:PO BOX 2596
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91943-2596
Mailing Address - Country:US
Mailing Address - Phone:281-445-5900
Mailing Address - Fax:281-445-5903
Practice Address - Street 1:9999 W MONTGOMERY RD
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-3100
Practice Address - Country:US
Practice Address - Phone:281-445-5900
Practice Address - Fax:281-445-5903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0502207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1824302Medicaid
TX1824302Medicaid