Healthcare Provider Details

I. General information

NPI: 1952358475
Provider Name (Legal Business Name): BARLITE SOUTHWEST KIDNEY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N SAN SABA STE 101
SAN ANTONIO TX
78207-3154
US

IV. Provider business mailing address

7500 BARLITE BLVD STE,103
SAN ANTONIO TX
78224-1361
US

V. Phone/Fax

Practice location:
  • Phone: 210-798-1955
  • Fax: 210-798-5424
Mailing address:
  • Phone: 210-922-3377
  • Fax: 210-798-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number008523
License Number StateTX

VIII. Authorized Official

Name: MISS SHARON MURRAY
Title or Position: BILLING MANAGER
Credential:
Phone: 210-922-3377