Basic Information
| Provider Information | |||||||||
| NPI: | 1710113014 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WOODLANDS-NORTH HOUSTON HEART ASSOCIATES, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WOODLANDS NORTH HOUSTON HEART CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 73627 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772733627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814443278 | ||||||||
| FaxNumber: | 8322493861 | ||||||||
| Practice Location | |||||||||
| Address1: | 17350 ST LUKES WAY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773844100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814443278 | ||||||||
| FaxNumber: | 8322493861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2009 | ||||||||
| LastUpdateDate: | 06/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | AQUINO | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2814443278 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 162737401 | 05 | TX | MEDICAID | DA4697 | 01 | TX | MEDICARE RR | OTHER |