=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245856087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS HEART MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2020
-----------------------------------------------------
Last Update Date | 07/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6624 FANNIN ST STE 2780
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2387
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-790-9401
-----------------------------------------------------
Fax | 713-790-0353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6770 BERTNER AVENUE
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-355-8173
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | HOWARD K. SCHRAMM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-355-8173
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------