MEDICARE: MEDICAL CENTER CATH LAB, LLP

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	246XC2901X	Cardiovascular Invasive Specialist/Technologist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CI4171	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00328K	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366587289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER CATH LAB, LLP

Provider Business Mailing Address
First Line	:	6400 FANNIN
Second Line	:	SUITE 3000
City	:	HOUSTON
State	:	TX
Zip	:	77030-1527
Country	:	US
Telephone Number	:	713-790-0841
Fax Number	:	713-790-1350

Provider Business Practice Location Address
First Line	:	6550 FANNIN
Second Line	:	SUITE 333
City	:	HOUSTON
State	:	TX
Zip	:	77030-2718
Country	:	US
Telephone Number	:	713-558-9508
Fax Number	:	713-790-1350

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DAVID S SAMUELS
Credential	:	M.D.
Telephone Number	:	713-790-0841

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	10/11/2012

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