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General NPI Number Information
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NPI Number | 1679018360
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Entity Type | Organization
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Legal Business Name | CARDIAC CATH LAB OF KINGWOOD, LP
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 19502 MCKAY DR SUITE 203
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City | HUMBLE
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State | TX
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Zip | 77338-5718
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Country | US
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Telephone | 713-812-7586
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Fax |
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Provider Business Mailing Address
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Address Line | 40 VALLEY STREAM PKWY STE 100
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City | MALVERN
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State | PA
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Zip | 19355-1407
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Country | US
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Telephone | 610-644-8900
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Fax | 484-924-0053
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Authorized Official
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Title or Position | SR. VICE PRESIDENT OPERATIONS
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Name | GREGG MILLER
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Credential | MD
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Telephone | 610-644-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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