=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639362213
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED CARDIOVASCULAR CARE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2007
-----------------------------------------------------
Last Update Date | 04/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25510 INTERSTATE 45 N STE 200
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77386-1376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-866-7701
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1125 CYPRESS STATION DR STE H-1
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77090-3054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-866-7701
-----------------------------------------------------
Fax | 281-866-7705
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. ANNIE T VARUGHESE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-866-7701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | J8408
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------