1083883193 NPI number — TOTAL WOUND SPECIALISTS, P.A.

Table of content: (NPI 1083883193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083883193 NPI number — TOTAL WOUND SPECIALISTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL WOUND SPECIALISTS, P.A.
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:
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:
1083883193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2935 THOUSAND OAKS
Provider Second Line Business Mailing Address:
SUITE 294
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78247-3312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-494-1100
Provider Business Mailing Address Fax Number:
210-494-1117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5101 MEDICAL 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:
78229-4801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-592-5349
Provider Business Practice Location Address Fax Number:
210-592-5462
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LARSON-LOHR
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
210-494-1100

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  H1292 , 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)

  • Identifier: 155302601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00090037 . This is a "MEDICAL RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 87960X . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: G25684 . This is a "UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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