Provider Demographics
NPI:1548565336
Name:CARDIO VIP - HOUSTON, LLC
Entity Type:Organization
Organization Name:CARDIO VIP - HOUSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-313-5332
Mailing Address - Street 1:9690 S 300 W
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3340
Mailing Address - Country:US
Mailing Address - Phone:281-313-5332
Mailing Address - Fax:801-858-4512
Practice Address - Street 1:1111 HIGHWAY 6
Practice Address - Street 2:SUITE 150
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4914
Practice Address - Country:US
Practice Address - Phone:281-313-5332
Practice Address - Fax:801-858-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology