Healthcare Provider Details

I. General information

NPI: 1376164475
Provider Name (Legal Business Name): ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19138 N US HWY 281 STE 300
SAN ANTONIO TX
78258-4988
US

IV. Provider business mailing address

19138 N US HWY 281
SAN ANTONIO TX
78258-4988
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-2660
  • Fax: 210-253-2661
Mailing address:
  • Phone: 210-253-2660
  • Fax: 210-253-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD BULLOCK
Title or Position: DIRECTOR OF AMBULATORY SERVICES
Credential:
Phone: 210-489-7278