MEDICARE: FOUR SEASONS BREAST FOUNDATION

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	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1770756660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUR SEASONS BREAST FOUNDATION

Provider Business Mailing Address
First Line	:	PO BOX 100840
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-8840
Country	:	US
Telephone Number	:	210-918-8510
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 S PIEDRAS DR STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1223
Country	:	US
Telephone Number	:	210-918-8510
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DIANE M ICENOGLE
Credential	:	M.D.
Telephone Number	:	210-918-8510

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

Similar Medicare Providers

1447366166 — ALAMO MOBILE X RAY & EKG SERVICES, INC.
Practice Location Address:

4400 PIEDRAS DR S , STE 140
SAN ANTONIO, TX
78228-1223

Practice Phone: 210-735-7889
Practice Fax: 210-735-3060

1649763517 — FOUR WINDS HOSPICE, INC
Practice Location Address:

4400 S PIEDRAS DR STE 215
SAN ANTONIO, TX
78228-1223

Practice Phone: 210-239-7719
Practice Fax: 210-817-8615

1649813874 — PRIME HOME HEALTH, LLC
Practice Location Address:

4400 S PIEDRAS DR STE 219
SAN ANTONIO, TX
78228-1223

Practice Phone: 210-251-4973
Practice Fax: 210-251-4467

1528738978 — KRISTOPHER L. RICHARDSON, PA-C, PLLC
Practice Location Address:

4400 S PIEDRAS DR STE 217
SAN ANTONIO, TX
78228-1223

Practice Phone: 210-831-6968
Practice Fax:

1184386161 — DIVERSITY HOLDINGS LLC
Practice Location Address:

4400 S PIEDRAS DR STE 219
SAN ANTONIO, TX
78228-1223

Practice Phone: 210-241-5692
Practice Fax:

1346906062 — GRACE & KRISTOPHER RICHARDSON PLLC
Practice Location Address:

4400 S PIEDRAS DR STE 217
SAN ANTONIO, TX
78228-1223

Practice Phone: 210-831-6968
Practice Fax:

Directions to “FOUR SEASONS BREAST FOUNDATION ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.