Provider Demographics
NPI:1427189539
Name:CARDIOVASCULAR ASSOCIATES OF SAN ANTONIO, PA
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF SAN ANTONIO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:L PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMULAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-225-4566
Mailing Address - Street 1:1123 N MAIN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4739
Mailing Address - Country:US
Mailing Address - Phone:210-225-4566
Mailing Address - Fax:210-225-5727
Practice Address - Street 1:1123 N MAIN AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212
Practice Address - Country:US
Practice Address - Phone:210-225-4566
Practice Address - Fax:210-225-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083715501Medicaid
TX00L34LMedicare ID - Type Unspecified