MEDICARE: HEART & VASCULAR CLINIC OF SAN ANTONIO, PLLC

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	207RC0000X	Cardiovascular Disease Physician	H 8897	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063799567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEART & VASCULAR CLINIC OF SAN ANTONIO, PLLC

Provider Business Mailing Address
First Line	:	927 MCCULLOUGH AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1630
Country	:	US
Telephone Number	:	210-223-6896
Fax Number	:	210-223-3888

Provider Business Practice Location Address
First Line	:	927 MCCULLOUGH AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1630
Country	:	US
Telephone Number	:	210-223-6896
Fax Number	:	210-223-3888

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	DR. WILLIAM C.L. WU
Credential	:	M.D.
Telephone Number	:	210-223-6896

Provider Enumeration Date	:	11/11/2011
Last Update Date	:	03/29/2012

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