Provider Demographics
NPI:1992920631
Name:SAN ANTONIO CARDIAC ASSOCIATES, PA
Entity type:Organization
Organization Name:SAN ANTONIO CARDIAC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:KOPECKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-3021
Mailing Address - Street 1:7922 EWING HALSELL
Mailing Address - Street 2:STE. 240
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-614-3021
Mailing Address - Fax:210-616-0208
Practice Address - Street 1:7922 EWING HALSELL
Practice Address - Street 2:STE. 240
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-3021
Practice Address - Fax:210-616-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0850976-01Medicaid
TX00T01EOtherBCBS OF TX
TX0850976-01Medicaid