MEDICARE: HEART MEDICAL GROUP, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center	N0821	TX

General Provider Information

NPI Number	:	1497907166
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART MEDICAL GROUP, P.A.

Provider Business Mailing Address
First Line	:	1926 SLUMBER PASS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-6235
Country	:	US
Telephone Number	:	210-481-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	19026 STONE OAK PKWY
Second Line	:	#205
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3227
Country	:	US
Telephone Number	:	210-317-4800
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LYUDMILA VASILIEVNA HARTT
Credential	:	M.D.
Telephone Number	:	210-317-4800

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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