Basic Information
| Provider Information | |||||||||
| NPI: | 1780998385 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CYPRESS HEART AND VASCULAR CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3686 | ||||||||
| Address2: | DEPT 475 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772533686 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326888400 | ||||||||
| FaxNumber: | 8326888430 | ||||||||
| Practice Location | |||||||||
| Address1: | 21212 NORTHWEST FWY STE 505 | ||||||||
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| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774295888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326888400 | ||||||||
| FaxNumber: | 8326888430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2010 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ALAMEDDINE | ||||||||
| AuthorizedOfficialFirstName: | FADI | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8326888400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 219301303 | 05 | TX | MEDICAID |