1104343276 NPI number — UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104343276 NPI number — UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
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:
1104343276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8431 FREDERICKSBURG RD FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-450-9000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7703 FLOYD CURL DR RM 1.422
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:
78229-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-567-9355
Provider Business Practice Location Address Fax Number:
210-567-5903
Provider Enumeration Date:
08/29/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MARKS
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VP OF BUSINESS AFFAIRS
Authorized Official Telephone Number:
210-450-9000

Provider Taxonomy Codes

  • Taxonomy code: 363LS0200X , 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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