Provider Demographics
NPI:1710070875
Name:INTERVENTIONAL CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:INTERVENTIONAL CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAIZNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-790-9125
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 2021
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-790-9125
Mailing Address - Fax:713-790-1802
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 2021
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-790-9125
Practice Address - Fax:713-790-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081554003Medicaid
TX081554001Medicaid
TX081554002Medicaid
TX00A52WMedicare PIN
TX081554002Medicaid
TX081554001Medicaid