MEDICARE: METRO NORTH CARDIOVASCULAR ASSOCIATES, P.A

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	H9639	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CC8198	OTHER	TX	MEDICARE RAILROAD

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	83Z820	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1962602763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METRO NORTH CARDIOVASCULAR ASSOCIATES, P.A

Provider Business Mailing Address
First Line	:	1003 NE LOOP 410
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1205
Country	:	US
Telephone Number	:	210-654-6000
Fax Number	:	210-654-6014

Provider Business Practice Location Address
First Line	:	1003 NE LOOP 410
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1205
Country	:	US
Telephone Number	:	210-654-6000
Fax Number	:	210-654-6014

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. PEGGY SUE GAROUTTE
Credential	:
Telephone Number	:	210-654-6000

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	12/18/2014

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Directions to “METRO NORTH CARDIOVASCULAR ASSOCIATES, P.A ” Practice Location

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