1184623647 NPI number — SOUTH TEXAS CARDIOVASCULAR CONSULTANTS

Table of content: (NPI 1184623647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184623647 NPI number — SOUTH TEXAS CARDIOVASCULAR CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH TEXAS CARDIOVASCULAR CONSULTANTS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184623647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78299-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-615-7734
Provider Business Mailing Address Fax Number:
210-615-7787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4330 MEDICAL DR
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-692-1414
Provider Business Practice Location Address Fax Number:
210-615-7787
Provider Enumeration Date:
07/18/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HURLEY
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
210-615-7734

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  J9310 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RC0001X , with the licence number: J9310 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)