Provider Demographics
NPI:1831115849
Name:CDA CONROE DIAGNOSTIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:CDA CONROE DIAGNOSTIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NHUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-248-5636
Mailing Address - Street 1:19 THUNDERCREEK PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6130
Mailing Address - Country:US
Mailing Address - Phone:936-273-3567
Mailing Address - Fax:936-273-5520
Practice Address - Street 1:19 THUNDERCREEK PL
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-6130
Practice Address - Country:US
Practice Address - Phone:936-273-3567
Practice Address - Fax:936-273-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7755208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00W300Medicare ID - Type Unspecified