1164856787 NPI number — SAN ANTONIO OSTEO RELIEF CENTER PA

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 1164856787 NPI number — SAN ANTONIO OSTEO RELIEF CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO OSTEO RELIEF CENTER PA
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:
1164856787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19016 STONE OAK PKWY
Provider Second Line Business Mailing Address:
STE 280
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-3280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-545-5128
Provider Business Mailing Address Fax Number:
210-545-5120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12180 N MOPAC EXPY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-2909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-836-8800
Provider Business Practice Location Address Fax Number:
512-836-8801
Provider Enumeration Date:
08/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KEMPF
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER / PROVIDER
Authorized Official Telephone Number:
512-836-8800

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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