Healthcare Provider Details

I. General information

NPI: 1700276573
Provider Name (Legal Business Name): SOUTH TEXAS HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21902 FRANKLIN PARK APT 1308
SAN ANTONIO TX
78259-2193
US

IV. Provider business mailing address

1150 N LOOP 1604 W SUITE 108-629
SAN ANTONIO TX
78248-4503
US

V. Phone/Fax

Practice location:
  • Phone: 210-491-1690
  • Fax: 210-491-1801
Mailing address:
  • Phone: 210-682-0140
  • Fax: 210-682-3238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM0453
License Number StateTX

VIII. Authorized Official

Name: DR. JIBRAIL KASPERKHAN
Title or Position: OWNER
Credential: M.D.
Phone: 210-491-1690