Provider Demographics
NPI:1952515439
Name:NORTHWEST HOUSTON CARDIOLOGY, PA
Entity type:Organization
Organization Name:NORTHWEST HOUSTON CARDIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADITYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-469-8007
Mailing Address - Street 1:13325 HARGRAVE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4539
Mailing Address - Country:US
Mailing Address - Phone:281-469-8007
Mailing Address - Fax:
Practice Address - Street 1:13325 HARGRAVE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4539
Practice Address - Country:US
Practice Address - Phone:281-469-8007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170175701Medicaid
TX170175701Medicaid