Provider Demographics
NPI:1699733303
Name:HOUSTON DIAGNOSTIC CATH LAB LP
Entity type:Organization
Organization Name:HOUSTON DIAGNOSTIC CATH LAB LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-580-0401
Mailing Address - Street 1:2130 W HOLCOMBE BLVD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3305
Mailing Address - Country:US
Mailing Address - Phone:713-580-0401
Mailing Address - Fax:713-580-0411
Practice Address - Street 1:2130 W HOLCOMBE BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3305
Practice Address - Country:US
Practice Address - Phone:713-580-0401
Practice Address - Fax:713-580-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00760XMedicare Oscar/Certification