Provider Demographics
NPI:1760423263
Name:HOUSTON CARDIAC CLINIC P.A.
Entity Type:Organization
Organization Name:HOUSTON CARDIAC CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNAWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-827-7680
Mailing Address - Street 1:925 GESSNER RD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2545
Mailing Address - Country:US
Mailing Address - Phone:713-827-7680
Mailing Address - Fax:713-827-0210
Practice Address - Street 1:925 GESSNER RD
Practice Address - Street 2:SUITE 525
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2545
Practice Address - Country:US
Practice Address - Phone:713-827-7680
Practice Address - Fax:713-827-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081719901Medicaid
TX081719901Medicaid
CP2355Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TX081719901Medicaid
0102395OtherBCBS OF TENESSEE
CP2355Medicare ID - Type UnspecifiedRAILROAD MEDICARE