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General NPI Number Information
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NPI Number | 1639724164
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Entity Type | Organization
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Legal Business Name | PREMIER CARDIOLOGY CLINIC PLLC
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Dates
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Enumeration Date | 08/01/2019
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 16969 N TEXAS AVE STE 100
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City | WEBSTER
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State | TX
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Zip | 77598-4094
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Country | US
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Telephone | 281-694-4555
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Fax | 271-694-9555
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Provider Business Mailing Address
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Address Line | PO BOX 4897
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City | HOUSTON
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State | TX
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Zip | 77210-4897
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Country | US
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Telephone | 281-694-4555
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Fax | 281-694-9555
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Authorized Official
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Title or Position | BILLING
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Name | KIMBERLY PHILLIPS
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Credential |
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Telephone | 713-854-2627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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