Healthcare Provider Details

I. General information

NPI: 1801100557
Provider Name (Legal Business Name): THE SAN ANTONIO ORTHOPAEDIC GROUP, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12602 TOEPPERWEIN RD SUITE 210
LIVE OAK TX
78233-3271
US

IV. Provider business mailing address

12602 TOEPPERWEIN RD SUITE 210
LIVE OAK TX
78233-3271
US

V. Phone/Fax

Practice location:
  • Phone: 210-804-5400
  • Fax: 210-678-4142
Mailing address:
  • Phone: 210-804-5400
  • Fax: 210-678-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE M. KEAN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 210-804-5400