Provider Demographics
NPI:1770184012
Name:HEROES HEALTHCARE PLLC
Entity Type:Organization
Organization Name:HEROES HEALTHCARE PLLC
Other - Org Name:HEREOS HEALTHCARE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:FACKELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RN, FNP-C
Authorized Official - Phone:210-957-1419
Mailing Address - Street 1:8500 VILLAGE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8500 VILLAGE DR STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5510
Practice Address - Country:US
Practice Address - Phone:210-957-1419
Practice Address - Fax:210-957-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty