=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003205873
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART AND RHYTHM INSTITUTE OF SOUTH TEXAS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/16/2015
-----------------------------------------------------
Last Update Date | 08/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8122 DATAPOINT DR STE 120
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-998-6900
-----------------------------------------------------
Fax | 210-998-6907
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1436
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78295-1436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-998-6900
-----------------------------------------------------
Fax | 210-998-6907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WASSIM K CHOUCAIR
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 361-779-3094
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | L4299
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0001X
-----------------------------------------------------
Taxonomy Name | Clinical Cardiac Electrophysiology Physician
-----------------------------------------------------
License Number | L4299
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------