Provider Demographics
NPI:1962602763
Name:METRO NORTH CARDIOVASCULAR ASSOCIATES, P.A
Entity type:Organization
Organization Name:METRO NORTH CARDIOVASCULAR ASSOCIATES, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GAROUTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-654-6000
Mailing Address - Street 1:1003 NE LOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1205
Mailing Address - Country:US
Mailing Address - Phone:210-654-6000
Mailing Address - Fax:210-654-6014
Practice Address - Street 1:1003 NE LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1205
Practice Address - Country:US
Practice Address - Phone:210-654-6000
Practice Address - Fax:210-654-6014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085790602Medicaid
TX83Z820OtherBCBS
TXCC8198OtherMEDICARE RAILROAD
TXCC8198OtherMEDICARE RAILROAD