1992920631 NPI number — SAN ANTONIO CARDIAC ASSOCIATES, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992920631 NPI number — SAN ANTONIO CARDIAC ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO CARDIAC ASSOCIATES, PA
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:
1992920631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7922 EWING HALSELL
Provider Second Line Business Mailing Address:
STE. 240
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-614-3021
Provider Business Mailing Address Fax Number:
210-616-0208

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7922 EWING HALSELL
Provider Second Line Business Practice Location Address:
STE. 240
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-3021
Provider Business Practice Location Address Fax Number:
210-616-0208
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOPECKY
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
LEON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-614-3021

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0850976-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00T01E . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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