=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306169990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARDIAC CATH LAB OF TOMBALL LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2010
-----------------------------------------------------
Last Update Date | 09/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18220 STATE HIGHWAY 249 SUITE 365
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77070-4347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-255-4222
-----------------------------------------------------
Fax | 281-255-4236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18220 STATE HIGHWAY 249 SUITE 365
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77070-4347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-255-4222
-----------------------------------------------------
Fax | 281-255-4236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. JAMES SPELLMIRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-812-7586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------