1295769214 NPI number — SAN ANTONIO SPECIALTY HOSPITAL LTD

Table of content: (NPI 1295769214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295769214 NPI number — SAN ANTONIO SPECIALTY HOSPITAL LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO SPECIALTY HOSPITAL LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295769214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5560 TENNYSON PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75024-3532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-241-2100
Provider Business Mailing Address Fax Number:
469-241-5198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8902 FLOYD CURL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-575-8005
Provider Business Practice Location Address Fax Number:
210-575-8041
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRONIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF REIMBURSEMENT
Authorized Official Telephone Number:
469-241-2128

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  000815 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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