Provider Demographics
NPI:1639161763
Name:SOUTH TEXAS CARDIOVASCULAR LABORATORY
Entity Type:Organization
Organization Name:SOUTH TEXAS CARDIOVASCULAR LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:E D
Authorized Official - Prefix:
Authorized Official - First Name:STCL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-615-7734
Mailing Address - Street 1:4330 MEDICAL DR
Mailing Address - Street 2:PAVILION SUITE A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3342
Mailing Address - Country:US
Mailing Address - Phone:210-615-7734
Mailing Address - Fax:
Practice Address - Street 1:4330 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3342
Practice Address - Country:US
Practice Address - Phone:210-615-7734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty