Provider Demographics
NPI:1639362213
Name:ADVANCED CARDIOVASCULAR CARE CENTER
Entity Type:Organization
Organization Name:ADVANCED CARDIOVASCULAR CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:VARUGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-866-7701
Mailing Address - Street 1:1125 CYPRESS STATION DR STE H-1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3054
Mailing Address - Country:US
Mailing Address - Phone:281-866-7701
Mailing Address - Fax:281-866-7705
Practice Address - Street 1:25510 INTERSTATE 45 N STE 200
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-1376
Practice Address - Country:US
Practice Address - Phone:281-866-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8408207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100168701Medicaid
TX167241201Medicaid
83760YOtherBLUE CROSS BLUE SHEILD TX
TX8A9462Medicare PIN
83760YOtherBLUE CROSS BLUE SHEILD TX
TX100168701Medicaid