Healthcare Provider Details

I. General information

NPI: 1275625097
Provider Name (Legal Business Name): BAYTOWN CARDIOLOGY AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GARTH RD STE 304
BAYTOWN TX
77521-3158
US

IV. Provider business mailing address

4301 GARTH RD STE 304
BAYTOWN TX
77521-3158
US

V. Phone/Fax

Practice location:
  • Phone: 281-837-6214
  • Fax: 281-837-6616
Mailing address:
  • Phone: 281-837-6214
  • Fax: 281-837-6616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License NumberL05040
License Number StateTX

VIII. Authorized Official

Name: DR. SARMA SUBRAHMANYA CHALLA
Title or Position: OWNER
Credential: M.D., F.A.C.C., P.A.
Phone: 281-420-2391