Healthcare Provider Details

I. General information

NPI: 1093034654
Provider Name (Legal Business Name): SOUTH TEXAS CARDIOLOGY INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 09/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 IH 10 W STE 200
SAN ANTONIO TX
78201-2041
US

IV. Provider business mailing address

6800 IH 10 W STE 200
SAN ANTONIO TX
78201-2041
US

V. Phone/Fax

Practice location:
  • Phone: 210-271-3203
  • Fax: 210-733-6983
Mailing address:
  • Phone: 210-271-3203
  • Fax: 210-733-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERTA CLOUD
Title or Position: VICE PRESIDENT
Credential:
Phone: 210-575-8501