Healthcare Provider Details

I. General information

NPI: 1194921056
Provider Name (Legal Business Name): H-E-B, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 SOUTH FLORES
SAN ANTONIO TX
78204
US

IV. Provider business mailing address

646 SOUTH FLORES
SAN ANTONIO TX
78204
US

V. Phone/Fax

Practice location:
  • Phone: 210-938-3182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID LIENDO
Title or Position: GOVERNMENT PROGRAMS MANAGER
Credential:
Phone: 210-938-3182