Healthcare Provider Details

I. General information

NPI: 1922243310
Provider Name (Legal Business Name): WOUND PROFESSIONAL SERVICES OF SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2008
Last Update Date: 12/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2833 BABCOCK RD STE 105
SAN ANTONIO TX
78229-4894
US

IV. Provider business mailing address

18407 ROGERS PIKE
SAN ANTONIO TX
78258-4610
US

V. Phone/Fax

Practice location:
  • Phone: 210-705-5030
  • Fax: 210-705-5035
Mailing address:
  • Phone: 210-807-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. ADRIANNE PATRICE SMITH
Title or Position: SENIOR PARTNER
Credential: MD
Phone: 210-807-2589