Provider Demographics
NPI:1659078632
Name:HENRY LEROY BURKHOLDER IV MD, PLLC
Entity Type:Organization
Organization Name:HENRY LEROY BURKHOLDER IV MD, PLLC
Other - Org Name:CATCH CARDIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:VP BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-737-5912
Mailing Address - Street 1:13100 WORTHAM CENTER DR FL 3
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5625
Mailing Address - Country:US
Mailing Address - Phone:713-737-5912
Mailing Address - Fax:
Practice Address - Street 1:17450 ST LUKES WAY STE 230
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8045
Practice Address - Country:US
Practice Address - Phone:281-843-8441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN7062OtherTEXAS MEDICAL BOARD
1134474380OtherNPI
LA332420OtherMD LICENSE
CODR.0067463OtherMD LICENSE