MEDICARE: SOUTHWEST CARDIOVASCULAR CONSULTANTS, 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	207RC0000X	Cardiovascular Disease Physician		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00FB19	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1306889159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST CARDIOVASCULAR CONSULTANTS, P.A.

Provider Business Mailing Address
First Line	:	6624 FANNIN ST
Second Line	:	SUITE 2220
City	:	HOUSTON
State	:	TX
Zip	:	77030-2334
Country	:	US
Telephone Number	:	713-791-9400
Fax Number	:	713-795-5651

Provider Business Practice Location Address
First Line	:	6624 FANNIN ST
Second Line	:	SUITE 2220
City	:	HOUSTON
State	:	TX
Zip	:	77030-2334
Country	:	US
Telephone Number	:	713-791-9400
Fax Number	:	713-795-5651

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JANICE D KELLEY
Credential	:
Telephone Number	:	713-791-9400

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	10/03/2007

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Directions to “SOUTHWEST CARDIOVASCULAR CONSULTANTS, P.A. ” Practice Location

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