Healthcare Provider Details

I. General information

NPI: 1780885103
Provider Name (Legal Business Name): SOUTH TEXAS VETERANS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17440 HENDERSON PASS
SAN ANTONIO TX
78232
US

IV. Provider business mailing address

8611 SHALLOW RIDGE DR
SAN ANTONIO TX
78239-4022
US

V. Phone/Fax

Practice location:
  • Phone: 210-483-5997
  • Fax:
Mailing address:
  • Phone: 210-656-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License NumberARRT055349
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number4042
License Number StateTX

VIII. Authorized Official

Name: MR. DAVID HEIER
Title or Position: ADMINITRATIVE OFFICER
Credential: MHA
Phone: 210-483-5791