Provider Demographics
NPI:1366587289
Name:MEDICAL CENTER CATH LAB, LLP
Entity type:Organization
Organization Name:MEDICAL CENTER CATH LAB, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-790-0841
Mailing Address - Street 1:6400 FANNIN
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1527
Mailing Address - Country:US
Mailing Address - Phone:713-790-0841
Mailing Address - Fax:713-790-1350
Practice Address - Street 1:6550 FANNIN
Practice Address - Street 2:SUITE 333
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2718
Practice Address - Country:US
Practice Address - Phone:713-558-9508
Practice Address - Fax:713-790-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00328KOtherBCBS
TXCI4171OtherRAILROAD MEDICARE
TX115263901Medicaid
TX00328KMedicare PIN