Healthcare Provider Details

I. General information

NPI: 1861549503
Provider Name (Legal Business Name): SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/23/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SPURS LN STE 300
SAN ANTONIO TX
78240-1679
US

IV. Provider business mailing address

21 SPURS LN STE 300
SAN ANTONIO TX
78240-1679
US

V. Phone/Fax

Practice location:
  • Phone: 210-561-7137
  • Fax: 210-561-7121
Mailing address:
  • Phone: 210-561-7137
  • Fax: 210-561-7121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE BIRKELO
Title or Position: CREDENTIALING
Credential:
Phone: 210-756-5240