Provider Demographics
NPI:1053758045
Name:SAN ANTONIO HEART PLLC
Entity type:Organization
Organization Name:SAN ANTONIO HEART PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOPPES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-270-2992
Mailing Address - Street 1:525 OAK CENTRE DR STE 270
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3917
Mailing Address - Country:US
Mailing Address - Phone:210-270-2992
Mailing Address - Fax:210-224-7898
Practice Address - Street 1:525 OAK CENTRE DR STE 270
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3917
Practice Address - Country:US
Practice Address - Phone:210-270-2992
Practice Address - Fax:210-224-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3343207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDU3664OtherRR MEDICARE
TX3267924-01Medicaid
TX307962Medicare PIN