Provider Demographics
NPI:1386632115
Name:CLINIC FOR CARDIOVASCULAR CARE
Entity type:Organization
Organization Name:CLINIC FOR CARDIOVASCULAR CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAQAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-255-2000
Mailing Address - Street 1:400 HOLDERRIETH BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4552
Mailing Address - Country:US
Mailing Address - Phone:281-255-2000
Mailing Address - Fax:281-378-5918
Practice Address - Street 1:400 HOLDERRIETH BLVD
Practice Address - Street 2:STE 104
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4543
Practice Address - Country:US
Practice Address - Phone:281-251-2000
Practice Address - Fax:281-378-5918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDC4545OtherRAILROAD MEDICARE
TX00791NMedicare PIN
TXDC4545OtherRAILROAD MEDICARE