Provider Demographics
NPI:1023330271
Name:ST. DAVID'S CARDIOLOGY, PLLC
Entity type:Organization
Organization Name:ST. DAVID'S CARDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REBOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-708-9700
Mailing Address - Street 1:1015 E 32ND ST
Mailing Address - Street 2:SUITE 508
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2707
Mailing Address - Country:US
Mailing Address - Phone:512-441-1633
Mailing Address - Fax:512-480-3153
Practice Address - Street 1:1015 E 32ND ST
Practice Address - Street 2:SUITE 508
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2707
Practice Address - Country:US
Practice Address - Phone:512-441-1633
Practice Address - Fax:512-480-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0079TEOtherBCBS PROVIDER RECORD
TX0A6159Medicare PIN