Provider Demographics
NPI:1497907166
Name:HEART MEDICAL GROUP, P.A.
Entity Type:Organization
Organization Name:HEART MEDICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:VASILIEVNA
Authorized Official - Last Name:HARTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-317-4800
Mailing Address - Street 1:1926 SLUMBER PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-6235
Mailing Address - Country:US
Mailing Address - Phone:210-481-0090
Mailing Address - Fax:
Practice Address - Street 1:19026 STONE OAK PKWY
Practice Address - Street 2:#205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3227
Practice Address - Country:US
Practice Address - Phone:210-317-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
TXN0821261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health