Provider Demographics
NPI:1982837605
Name:WOODLANDS HEART AND VASCULAR INSTITUTE, PA
Entity Type:Organization
Organization Name:WOODLANDS HEART AND VASCULAR INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-562-3974
Mailing Address - Street 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3260
Mailing Address - Country:US
Mailing Address - Phone:832-562-3974
Mailing Address - Fax:832-813-0233
Practice Address - Street 1:920 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 520
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3260
Practice Address - Country:US
Practice Address - Phone:832-562-3974
Practice Address - Fax:832-813-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7017207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0021SQOtherBLUE CROSS AND BLUE SHIELD OF TX
TXOA5416Medicare PIN
TXH41629Medicare UPIN