MEDICARE: KERRVILLE CARDIOVASCULAR CENTER

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	2471N0900X	Nuclear Medicine Technology Radiologic Technologist

General Provider Information

NPI Number	:	1124010277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERRVILLE CARDIOVASCULAR CENTER

Provider Business Mailing Address
First Line	:	PO BOX 293
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78291-0293
Country	:	US
Telephone Number	:	210-692-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 JUNCTION HWY
Second Line	:	SUITE 220
City	:	KERRVILLE
State	:	TX
Zip	:	78028-4247
Country	:	US
Telephone Number	:	830-792-7666
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	KVCC STC
Credential	:
Telephone Number	:	210-692-8811

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	11/08/2011

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