Provider Demographics
NPI:1598001323
Name:HEART CONSULTANTS OF SAN ANTONIO, PLLC
Entity Type:Organization
Organization Name:HEART CONSULTANTS OF SAN ANTONIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAZ-WIDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-229-1980
Mailing Address - Street 1:343 W HOUSTON ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2107
Mailing Address - Country:US
Mailing Address - Phone:210-229-1980
Mailing Address - Fax:210-229-1989
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:SUITE 209
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2833
Practice Address - Country:US
Practice Address - Phone:210-385-2624
Practice Address - Fax:830-249-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9050207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097134304Medicaid
TX8A8018Medicare PIN
TXH07695Medicare UPIN