MEDICARE: URSUS MOBILE MEDICAL PLLC

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	213E00000X	Podiatrist	0475	TX

General Provider Information

NPI Number	:	1215260344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URSUS MOBILE MEDICAL PLLC

Provider Business Mailing Address
First Line	:	12333 WETMORE RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-3638
Country	:	US
Telephone Number	:	210-495-6477
Fax Number	:	210-495-6484

Provider Business Practice Location Address
First Line	:	8500 VILLAGE DR
Second Line	:	SUITE 201
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-5515
Country	:	US
Telephone Number	:	210-656-7000
Fax Number	:	210-656-7002

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY JOE COHEN
Credential	:	DPM
Telephone Number	:	210-656-7000

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	09/08/2009

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