MEDICARE: PEDICATRIC CARDIOLOGY ASSOCIATES

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	2080P0202X	Pediatric Cardiology Physician

General Provider Information

NPI Number	:	1194886796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDICATRIC CARDIOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	4499 MEDICAL DRIVE
Second Line	:	SUITE 272
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3712
Country	:	US
Telephone Number	:	210-614-3264
Fax Number	:	210-692-3963

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DRIVE
Second Line	:	SUITE 272
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3712
Country	:	US
Telephone Number	:	210-614-3264
Fax Number	:	210-692-3963

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	MS. KAREN EVEREST
Credential	:
Telephone Number	:	210-614-3264

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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