Provider Demographics
NPI:1487965000
Name:CARDIOLOGY CLINIC OF SAN ANTONIO, PLLC
Entity type:Organization
Organization Name:CARDIOLOGY CLINIC OF SAN ANTONIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-575-8501
Mailing Address - Street 1:4411 MEDICAL DR
Mailing Address - Street 2:SUITE #300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3822
Mailing Address - Country:US
Mailing Address - Phone:210-614-5400
Mailing Address - Fax:210-614-5732
Practice Address - Street 1:4411 MEDICAL DR
Practice Address - Street 2:SUITE #300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3822
Practice Address - Country:US
Practice Address - Phone:210-614-5400
Practice Address - Fax:210-614-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH00040TV01OtherBCBS
TX218671001Medicaid
TXDR0519OtherMEDICARE RAILROAD