PREVENTICE SERVICES, LLC (NPI# 1063414258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063414258 |
| Entity Type | Organization |
| Organization Name | PREVENTICE SERVICES, LLC |
| Other Organization Name | ECARDIO DIAGNOSTICS, LLC |
| Practice Address |
1717 N Sam Houston Pkwy W Ste 100 Houston TX 77038-1324 |
| Practice Telephone | 2817600500 |
| Practice Fax Number | 8667474799 |
| Mailing Telephone | 2817600500 |
| Mailing Fax Number | 8667474799 |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2019-05-31 |
| Authorized Official Name | MR. JON P. OTTERSTATTER (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2817600500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 293D00000X | Physiological Laboratory | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS PROVIDER NUMBER | 009999 | 01 |
| MAMSI PROVIDER # | 7410317 | 01 | |
| TX | 172529301 | 05 |
| Other Name | Type Code |
|---|---|
| eCardio Diagnostics, LLC | Former Legal Business Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PREVENTICE SERVICES, LLC | 1717 N Sam Houston Pkwy W Ste 100, Houston, TX 77038-1324 |
| Oregon Corporations, Companies and Business Names | PREVENTICE SERVICES, LLC | 1717 N Sam Houston Pkwy W, Suite 100, Houston, TX 77038 |
| Washington State Corporations | PREVENTICE SERVICES, LLC | 1717 N Sam Houston Pkwy W Ste 100, Houston, TX 77038-1324 |
| Indiana Business Entities | PREVENTICE SERVICES, LLC | 1717 N. Sam Houston Parkway W, Ste 100, Houston, TX 77038-1312 |
| Street Address |
1717 N SAM HOUSTON PKWY W STE 100 |
| City | HOUSTON |
| State | TX |
| Zip Code | 77038-1324 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871869545 | My West Mount Houston Dentist Inc | Dentist | 1500 West Mount Houston Road, Houston, TX 77038 | 2012-03-28 |
| 1699820266 | Danh Quang Le | Chiropractor | 10625 Veterans Memorial Dr., Suite E, Houston, TX 77038 | 2007-01-24 |
| 1043319569 | Jimmy N Crawford | Dentist | 1500 West Mount Houston Rd, Houston, TX 77038 | 2006-09-21 |
| 1275636896 | Danh Q Le | Chiropractor | 10625 Veterans Memorial Dr, Suite E, Houston, TX 77038 | 2006-09-07 |
| 1457406639 | Advanced Spinal Treatment Center | Chiropractor | 10625 Veterans Memorial Dr, Ste E, Houston, TX 77038 | 2007-01-25 |
| 1205302080 | Ursula Knowles | Occupational Therapy Assistant | 2503 Nelwood Dr, Houston, TX 77038-1021 | 2018-10-18 |
| 1588913305 | Jade Truong | Nurse Practitioner | 10625 Veterans Memorial Dr Ste D, Houston, TX 77038-1047 | 2012-09-07 |
| 1386090280 | Phuong Pham | Nurse Practitioner | 10411 Veterans Memorial Dr, Suite A, Houston, TX 77038-1047 | 2016-05-10 |
| 1104227867 | Lorena Jimenez | Nurse Practitioner | 10625 Veterans Memorial Dr Ste D, Houston, TX 77038-1047 | 2014-09-11 |
| 1336484468 | Ann Vo | Nurse Practitioner | 10625 Veterans Memorial Dr Ste D, Houston, TX 77038-1047 | 2012-11-29 |
| Find all providers in zip 77038 | ||||
| Taxonomy Code | 293D00000X |
| Grouping | Laboratories |
| Classification | Physiological Laboratory |
| A laboratory that operates independently of a hospital and physician’s office to furnish physiological diagnostic services (e.g. EEG’s , EKG’s, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services. |
| Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447895396 | Intuit Testing LLC | Physiological Laboratory | 5431 Barker Cypress Rd Ste 600, Houston, TX 77084-7312 | 2019-11-14 |
| 1295387686 | Octagos Acquisition LLC | Physiological Laboratory | 13325 Hargrave Rd Ste 281, Houston, TX 77070-4539 | 2019-07-15 |
| 1770147514 | Medgroup Choice, LLC | Physiological Laboratory | 7 Riverway Unit 806, Houston, TX 77056-1989 | 2019-04-26 |
| 1801303235 | Sleeping Alpha LLC | Physiological Laboratory | 1616 Cullen Blvd, Houston, TX 77023-3046 | 2018-01-08 |
| 1225498173 | Johnny Gilbert | Physiological Laboratory | 529 Barker Clodine Rd, Apt. 25103, Houston, TX 77094-1447 | 2016-03-03 |
| 1124488085 | Bird Dog Pharma, LLC | Physiological Laboratory | 12242 Queenston Blvd Ste E, Houston, TX 77095-5353 | 2016-03-03 |
| 1508261033 | Us Meddx, Inc | Physiological Laboratory | 2950 North Loop W, Suite 500, Houston, TX 77092-8843 | 2014-10-27 |
| 1558636191 | Holistica, LLC | Physiological Laboratory | 1980 Post Oak Blvd Ste 1500, 1980 Post Oak Blvd, Ste 1500, Houston, TX 77056-3845 | 2012-03-15 |
| 1164799292 | Innovative Medical Assessments | Physiological Laboratory | 5200 Mitchelldale St Ste E16, Houston, TX 77092-7222 | 2011-11-17 |
| 1013292416 | Strategic Wellness & Health | Physiological Laboratory | 1051 Pineloch Dr Ste 800, Houston, TX 77062-2738 | 2011-10-17 |
| Find all providers in HOUSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.