MEDICARE: SOUTH TEXAS CARDIOLOGY INSTITUTE, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0006TQ	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1093034654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS CARDIOLOGY INSTITUTE, PLLC

Provider Business Mailing Address
First Line	:	6800 IH 10 W STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2041
Country	:	US
Telephone Number	:	210-271-3203
Fax Number	:	210-733-6983

Provider Business Practice Location Address
First Line	:	6800 IH 10 W STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-2041
Country	:	US
Telephone Number	:	210-271-3203
Fax Number	:	210-733-6983

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ROBERTA CLOUD
Credential	:
Telephone Number	:	210-575-8501

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	09/30/2010

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