Provider Demographics
NPI:1457462194
Name:CLINIC FOR CARDIOVASCULAR CARE
Entity Type:Organization
Organization Name:CLINIC FOR CARDIOVASCULAR CARE
Other - Org Name:LONE STAR HEART AND VASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAQAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-704-4844
Mailing Address - Street 1:400 HOLDERRIETH BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4595
Mailing Address - Country:US
Mailing Address - Phone:281-255-2000
Mailing Address - Fax:281-378-5918
Practice Address - Street 1:400 HOLDERRIETH BLVD
Practice Address - Street 2:STE 104
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-255-2000
Practice Address - Fax:281-378-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321558401Medicaid
TX00719NMedicare PIN