MEDICARE: ST. LUKE'S DIAGNOSTIC CATH LAB, LLP

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	261Q00000X	Clinic/Center	N/A

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00279815	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HH1827	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1841296357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LUKE'S DIAGNOSTIC CATH LAB, LLP

Provider Business Mailing Address
First Line	:	6620 MAIN STREET
Second Line	:	SUITE 1520
City	:	HOUSTON
State	:	TX
Zip	:	77030-2305
Country	:	US
Telephone Number	:	713-275-2200
Fax Number	:	713-275-2222

Provider Business Practice Location Address
First Line	:	6620 MAIN STREET
Second Line	:	SUITE 1520
City	:	HOUSTON
State	:	TX
Zip	:	77030-2305
Country	:	US
Telephone Number	:	713-275-2200
Fax Number	:	713-275-2222

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	PATRICIA CHESNICK
Credential	:	RN
Telephone Number	:	713-275-2200

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	04/12/2024

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