MEDICARE: INTERVENTIONAL CARDIOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF8541	OTHER	TX	MEDICARE B RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0035NZ	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013019157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL CARDIOLOGY

Provider Business Mailing Address
First Line	:	19255 PARK ROW STE 204
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-7310
Country	:	US
Telephone Number	:	281-829-3860
Fax Number	:	281-829-3861

Provider Business Practice Location Address
First Line	:	19255 PARK ROW STE 204
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-7310
Country	:	US
Telephone Number	:	281-829-3860
Fax Number	:	281-829-3861

Authorized Official
Title or Position	:	PRACTICE MGR
Name	:	PAT LICHT
Credential	:
Telephone Number	:	281-829-3860

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	03/17/2018

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Directions to “INTERVENTIONAL CARDIOLOGY ” Practice Location

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