Healthcare Provider Details

I. General information

NPI: 1992070155
Provider Name (Legal Business Name): CARDIAC CATH LAB OF NW HOUSTON, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 W 20TH ST SUITE 300
HOUSTON TX
77008-2441
US

IV. Provider business mailing address

427 W 20TH ST SUITE 300
HOUSTON TX
77008-2441
US

V. Phone/Fax

Practice location:
  • Phone: 713-861-0300
  • Fax: 713-861-0302
Mailing address:
  • Phone: 713-861-0300
  • Fax: 713-861-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: WALER E SCHWING JR.
Title or Position: CHAIRMAN
Credential:
Phone: 713-861-0300