Healthcare Provider Details

I. General information

NPI: 1336416445
Provider Name (Legal Business Name): UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 DARNALL LOOP # 47 ROOM 1417
FORT HOOD TX
76544-5095
US

IV. Provider business mailing address

36000 DARNALL LOOP # 47 ROOM 1417
FORT HOOD TX
76544-5095
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-1638
  • Fax:
Mailing address:
  • Phone: 254-288-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MS. SUSAN DIANN PASCHALL
Title or Position: INDEPENDENT EVALUATOR
Credential: M.S.
Phone: 214-577-7815