Provider Demographics
NPI:1538124458
Name:MEMORIAL CITY CARDIOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:MEMORIAL CITY CARDIOLOGY ASSOCIATES INC
Other - Org Name:MEMORIAL KATY CARDIOLOGY VEIN & VASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODHAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-464-2928
Mailing Address - Street 1:1331 W GRAND PKWY N STE 130
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2711
Mailing Address - Country:US
Mailing Address - Phone:281-392-3401
Mailing Address - Fax:281-392-7814
Practice Address - Street 1:10496 KATY FWY STE 130
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043
Practice Address - Country:US
Practice Address - Phone:713-464-2928
Practice Address - Fax:713-464-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R225OtherBC/BS
TX084702201Medicaid