Provider Demographics
NPI:1437284460
Name:SAN ANTONIO DIGESTIVE DISEASE CONSULTANTS PA
Entity Type:Organization
Organization Name:SAN ANTONIO DIGESTIVE DISEASE CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HEAME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-828-8400
Mailing Address - Street 1:1804 N.E. LOOP 410
Mailing Address - Street 2:# 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5211
Mailing Address - Country:US
Mailing Address - Phone:210-828-8400
Mailing Address - Fax:210-804-4454
Practice Address - Street 1:1804 N.E. LOOP 410
Practice Address - Street 2:# 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5211
Practice Address - Country:US
Practice Address - Phone:210-828-8400
Practice Address - Fax:210-804-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084814501Medicaid
TX00R53CMedicare PIN