Provider Demographics
NPI:1124010277
Name:KERRVILLE CARDIOVASCULAR CENTER
Entity Type:Organization
Organization Name:KERRVILLE CARDIOVASCULAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KVCC
Authorized Official - Middle Name:
Authorized Official - Last Name:STC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-692-8811
Mailing Address - Street 1:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0293
Mailing Address - Country:US
Mailing Address - Phone:210-692-8811
Mailing Address - Fax:
Practice Address - Street 1:301 JUNCTION HWY
Practice Address - Street 2:SUITE 220
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4247
Practice Address - Country:US
Practice Address - Phone:830-792-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTNC02Medicare PIN