Healthcare Provider Details

I. General information

NPI: 1881028801
Provider Name (Legal Business Name): SAN ANTONIO HEART IMAGING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19276 STONE OAK PKWY SUITE 103 A
SAN ANTONIO TX
78258-3378
US

IV. Provider business mailing address

19276 STONE OAK PKWY SUITE 103 A
SAN ANTONIO TX
78258-3378
US

V. Phone/Fax

Practice location:
  • Phone: 210-403-9170
  • Fax: 210-403-9188
Mailing address:
  • Phone: 210-403-9170
  • Fax: 210-403-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberL06569
License Number StateTX

VIII. Authorized Official

Name: DR. GERALD M KOPPES
Title or Position: PRESIDENT
Credential: MD
Phone: 210-403-9170