MEDICARE: BOSTON SCIENTIFIC CARDIAC DIAGNOSTIC SERVICES, LLC

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	293D00000X	Physiological Laboratory

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	009999	OTHER	TX	BCBS PROVIDER NUMBER
3	7410317	OTHER		MAMSI PROVIDER #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063414258
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOSTON SCIENTIFIC CARDIAC DIAGNOSTIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	1717 N SAM HOUSTON PKWY W STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77038-1324
Country	:	US
Telephone Number	:	281-760-0500
Fax Number	:	866-747-4799

Provider Business Practice Location Address
First Line	:	1717 N SAM HOUSTON PKWY W STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77038-1324
Country	:	US
Telephone Number	:	281-760-0500
Fax Number	:	866-747-4799

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. TONY FIOLA
Credential	:
Telephone Number	:	651-260-4411

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/02/2024

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