Provider Demographics
NPI:1750476230
Name:CARDIOVASCULAR ASSOCIATION, P.L.L.C
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATION, P.L.L.C
Other - Org Name:VITAL HEART AND VEIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-572-0224
Mailing Address - Street 1:18450 HIGHWAY 59 N
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338
Mailing Address - Country:US
Mailing Address - Phone:281-446-6656
Mailing Address - Fax:281-446-6657
Practice Address - Street 1:18450 HIGHWAY 59 N
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4404
Practice Address - Country:US
Practice Address - Phone:281-446-6656
Practice Address - Fax:281-446-6657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCN9534OtherRAILROAD MEDICARE-PALMETT
TX1750476230Medicaid
TX0007CVOtherBCBS
TX0007CVOtherBCBS
TX0007CVOtherBCBS