Provider Demographics
NPI:1679767875
Name:CENTER FOR MINMALLY INVASIVE CARDIOVASCULAR & THORACIC SURGERY PA
Entity type:Organization
Organization Name:CENTER FOR MINMALLY INVASIVE CARDIOVASCULAR & THORACIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-447-3679
Mailing Address - Street 1:P.O. BOX 2636
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3987
Mailing Address - Country:US
Mailing Address - Phone:210-615-6626
Mailing Address - Fax:210-615-1318
Practice Address - Street 1:225 E SONTERRA BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3992
Practice Address - Country:US
Practice Address - Phone:210-615-6626
Practice Address - Fax:210-615-1318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7417208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0063RDOtherBLUE CROSS BLUE SHIELD
TX0063RDOtherBLUE CROSS BLUE SHIELD
TXE46792Medicare UPIN