MEDICARE: CENTRAL CARDIOVASCULAR INSTITUTE OF SAN ANTONIO

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0018CK	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184618050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL CARDIOVASCULAR INSTITUTE OF SAN ANTONIO

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
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1630
Country	:	US
Telephone Number	:	210-867-3203
Fax Number	:	210-223-3888

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	WILLIAM C L WU
Credential	:	MD
Telephone Number	:	210-867-3202

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	04/03/2012

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