Healthcare Provider Details

I. General information

NPI: 1699181784
Provider Name (Legal Business Name): HEART & LUNG CENTER OF SOUTHEAST TEXAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21212 NORTHWEST FWY STE 265
CYPRESS TX
77429-5883
US

IV. Provider business mailing address

21212 NORTHWEST FWY STE 265
CYPRESS TX
77429-5883
US

V. Phone/Fax

Practice location:
  • Phone: 281-653-9123
  • Fax: 281-653-9175
Mailing address:
  • Phone: 281-653-9123
  • Fax: 281-653-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberN7264
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number36561
License Number StateTN

VIII. Authorized Official

Name: ANIL GOLI
Title or Position: CEO
Credential:
Phone: 281-653-9123