Provider Demographics
NPI:1538333448
Name:MONTGOMERY COUNTY CARDIOVASCULAR ASSOCIATES PA
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY CARDIOVASCULAR ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARUNAKAR P.
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-441-8010
Mailing Address - Street 1:2101 S LOOP 336 W
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3711
Mailing Address - Country:US
Mailing Address - Phone:936-441-8010
Mailing Address - Fax:936-760-2532
Practice Address - Street 1:2101 S LOOP 336 W
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3711
Practice Address - Country:US
Practice Address - Phone:936-441-8010
Practice Address - Fax:936-760-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1022207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085410101Medicaid
TX00T84KMedicare PIN
TX085410101Medicaid