MEDICARE: WILLOWBROOK CARDIOVASCULAR ASSOCIATES, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0001X	Clinical Cardiac Electrophysiology Physician	207RC0001X	TX
2	207RI0011X	Interventional Cardiology Physician	207RI0011X	TX
3	207RC0000X	Cardiovascular Disease Physician	207RC0000X	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194789974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOWBROOK CARDIOVASCULAR ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	13300 HARGRAVE RD
Second Line	:	STE 500
City	:	HOUSTON
State	:	TX
Zip	:	77070-4373
Country	:	US
Telephone Number	:	281-890-4848
Fax Number	:	281-890-4885

Provider Business Practice Location Address
First Line	:	13300 HARGRAVE RD
Second Line	:	STE 500
City	:	HOUSTON
State	:	TX
Zip	:	77070-4373
Country	:	US
Telephone Number	:	281-890-4848
Fax Number	:	281-890-4885

Authorized Official
Title or Position	:	CHIEF FINACIAL OFFICER
Name	:	DR. JOHN CHARLES ISAAC
Credential	:	M.D,
Telephone Number	:	281-890-4848

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	03/10/2010

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