MEDICARE: SIOCO CARDIOLOGY, PA

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	J2337	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
2	0015GN	OTHER	TX	BCBS GRP

General Provider Information

NPI Number	:	1235252958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIOCO CARDIOLOGY, PA

Provider Business Mailing Address
First Line	:	1545 BENTON WOODS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4494
Country	:	US
Telephone Number	:	210-614-8800
Fax Number	:	210-614-8880

Provider Business Practice Location Address
First Line	:	9465 HUEBNER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1508
Country	:	US
Telephone Number	:	210-614-8800
Fax Number	:	210-614-8880

Authorized Official
Title or Position	:	OWNER
Name	:	GERALD M SIOCO
Credential	:	MD
Telephone Number	:	210-614-8800

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/17/2023

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