Provider Demographics
NPI:1184618050
Name:CENTRAL CARDIOVASCULAR INSTITUTE OF SAN ANTONIO
Entity type:Organization
Organization Name:CENTRAL CARDIOVASCULAR INSTITUTE OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C L
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-867-3202
Mailing Address - Street 1:927 MCCULLOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1630
Mailing Address - Country:US
Mailing Address - Phone:210-223-6896
Mailing Address - Fax:210-223-3888
Practice Address - Street 1:927 MCCULLOUGH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1630
Practice Address - Country:US
Practice Address - Phone:210-867-3203
Practice Address - Fax:210-223-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0018CKOtherBCBS
TX084973902Medicaid
TX00R98HMedicare ID - Type Unspecified