Provider Demographics
NPI:1710096714
Name:SOUTH TEXAS HEARTBEAT, P A
Entity Type:Organization
Organization Name:SOUTH TEXAS HEARTBEAT, P A
Other - Org Name:SOUTH TEXAS HEARTBEAT PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PACHULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-408-2343
Mailing Address - Street 1:150 E. SONTERRA
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4387
Mailing Address - Country:US
Mailing Address - Phone:210-408-2343
Mailing Address - Fax:210-408-8329
Practice Address - Street 1:150 E. SONTERRA
Practice Address - Street 2:SUITE 230
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4387
Practice Address - Country:US
Practice Address - Phone:210-408-2343
Practice Address - Fax:210-408-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9413207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035MWOtherGROUP BCBS #
TX177066101Medicaid
TX177066101Medicaid
TX0035MWOtherGROUP BCBS #