MEDICARE: DEPARTMENT OF STATE HEALTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP0905X	State or Local Public Health Clinic/Center		TX

General Provider Information

NPI Number	:	1033285168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF STATE HEALTH SERVICES

Provider Business Mailing Address
First Line	:	1100 W 49TH ST
Second Line	:	HSR 8 - SAN ANTONIO
City	:	AUSTIN
State	:	TX
Zip	:	78756-3101
Country	:	US
Telephone Number	:	512-458-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	7430 LOUIS PASTEUR DR
Second Line	:	ATTN BILLING OFFICE
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4507
Country	:	US
Telephone Number	:	210-949-2000
Fax Number	:	210-949-2015

Authorized Official
Title or Position	:	DEPUTY REGIONAL DIRECTOR
Name	:	ANITA MARTINEZ
Credential	:
Telephone Number	:	210-949-2000

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	08/22/2020

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Directions to “DEPARTMENT OF STATE HEALTH SERVICES ” Practice Location

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