Provider Demographics
NPI:1235252958
Name:SIOCO CARDIOLOGY, PA
Entity Type:Organization
Organization Name:SIOCO CARDIOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIOCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-8800
Mailing Address - Street 1:1545 BENTON WOODS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4494
Mailing Address - Country:US
Mailing Address - Phone:210-614-8800
Mailing Address - Fax:210-614-8880
Practice Address - Street 1:9465 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1508
Practice Address - Country:US
Practice Address - Phone:210-614-8800
Practice Address - Fax:210-614-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2337207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211085001Medicaid
TX0015GNOtherBCBS GRP
TX0A4811Medicare PIN