MEDICARE: UTC PROVIDERS - SAN ANTONIO INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111NR0400X	Rehabilitation Chiropractor
2	363AM0700X	Medical Physician Assistant
3	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1952715070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTC PROVIDERS - SAN ANTONIO INC

Provider Business Mailing Address
First Line	:	8900 SHOAL CREEK BLVD STE 300
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-6853
Country	:	US
Telephone Number	:	512-323-6900
Fax Number	:	512-375-3865

Provider Business Practice Location Address
First Line	:	200 E RAMSEY RD
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4607
Country	:	US
Telephone Number	:	210-497-4878
Fax Number	:	512-375-3865

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR, RCM DIVISION
Name	:	NATHALIE BLACKSTOCK
Credential	:
Telephone Number	:	512-323-6900

Provider Enumeration Date	:	06/17/2014
Last Update Date	:	02/26/2015

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Directions to “UTC PROVIDERS - SAN ANTONIO INC ” Practice Location

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