NPIMap

Organization Active NPI

Cardiac Cath Lab of Conroe, LP

Doing business as College Park Heart & Vascular Center

  • Multi-Specialty Clinic/Center
  • Shenandoah, TX
National Provider Identifier
1194005603
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
CARDIAC CATH LAB OF CONROE, LP
Doing business as
College Park Heart & Vascular Center
Practice address
17183 I 45 S Ste 350
Shenandoah, TX 77385-3313
Phone
(936) 321-0080
Fax
(936) 321-0081
NPI assigned
Aug 29, 2011
Last updated
Nov 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kelly Marie Bemis
Title
Authorized Official
Phone
(858) 504-5667

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

17183 I 45 S Ste 350
Shenandoah, TX 77385-3313

Mailing address

Dept# 3013, PO Box 4417
Houston, TX 77210
Phone (610) 644-8900

Other names 1

  • College Park Heart & Vascular Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120430000018 TX Part B Supplier - Clinic/Group Practice 4789846262 Receives reassigned benefits from 26 practitioners
Practice locations: Shenandoah, TX

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2035525Cardiac Cath Lab of Conroe17183 I-45 South Suite 350, The Woodlands, TX 77385AccreditationMay 26, 2027

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

  • Conroe ASC, LP

    dba College Park Heart & Vascular Surgery Center

    • Ambulatory Surgical Clinic/Center
    • The Woodlands, TX
    • NPI 1194271338

    Member Of

    NPD member

Locations

17191 St Lukes Way
Ste 2B
Conroe, TX 77384

17191 St Lukes Way
Ste 1A
The Woodlands, TX 77384
Phone (936) 321-0080

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1194005603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT# 3013, PO BOX 4417",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "77210",
            "telephone_number": "610-644-8900",
            "fax_number": "484-924-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17183 I 45 S STE 350",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773853313",
            "telephone_number": "936-321-0080",
            "fax_number": "936-321-0081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIAC CATH LAB OF CONROE, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-29",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "BEMIS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "858-504-5667"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "College Park Heart & Vascular Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "College Park Heart & Vascular Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shenandoah, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.