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  7. NPI Record 1295173680

CARDIAC WELLNESS CLINIC
Complete NPI Record 1295173680
Internal Medicine - Cardiovascular Disease in Pearland, TX

NPI Status: Active since June 07, 2013

Contact Information

1930 COUNTRY PLACE PKWY STE 106
PEARLAND, TX
ZIP 77584
Phone: (281) 506-7840
Fax: (832) 672-7485

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Second Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Authorized Official Last Name
  25. Authorized Official First Name
  26. Authorized Official Middle Name
  27. Authorized Official Title or Position
  28. Authorized Official Telephone Number
  29. Healthcare Provider Taxonomy Code 1
  30. Provider License Number 1
  31. Provider License Number State Code 1
  32. Healthcare Provider Primary Taxonomy Switch 1
  33. Is Organization Subpart
  34. Authorized Official Credential Text
  35. Healthcare Provider Taxonomy Group 1

Complete NPI Dataset

This page represents the complete record for NPI 1295173680. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1295173680
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Entity Type Code: 2
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Employer Identification Number EIN: UNAVAIL
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Other Organization Name: CARDIAC WELLNESS CLINIC
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider Other Organization Name Type Code: 3
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider First Line Business Mailing Address: 10223 BROADWAY STREET
The city name in the location address of the provider being identified.
Provider Second Line Business Mailing Address: SUITE: P-226
The State code in the location of the provider being identified.
Provider Business Mailing Address City Name: PEARLAND
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Mailing Address State Name: TX
The country code in the location address of the provider being identified.
Provider Business Mailing Address Postal Code: 78584
The telephone number associated with the location address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Mailing Address Telephone Number: 2818864183
The date that a record was last updated or changed.
Provider Business Mailing Address Fax Number: 7134363489
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 1930 COUNTRY PLACE PKWY STE 106
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: PEARLAND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: TX
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 775842138
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 2815067840
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 8326727485
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 6/7/2013
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 12/19/2017
The date that a record was last updated or changed.
Authorized Official Last Name: YU
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: JOHN
The first name of the authorized official.
Authorized Official Middle Name: C. L.
The middle name of the authorized official.
Authorized Official Title or Position: SOLE OWNER
The title or position of the authorized official.
Authorized Official Telephone Number: 2815067840
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 207RC0000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: J7735
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: TX
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Credential Text: MD
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP