Healthcare Provider Details

I. General information

NPI: 1922075167
Provider Name (Legal Business Name): NORTH CENTRAL METHODIST ASC, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19010 STONE OAK PKWY
SAN ANTONIO TX
78258-3225
US

IV. Provider business mailing address

19010 STONE OAK PKWY
SAN ANTONIO TX
78258-3225
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-5200
  • Fax: 210-575-5222
Mailing address:
  • Phone: 210-575-5200
  • Fax: 210-575-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number007843
License Number StateTX

VIII. Authorized Official

Name: TIMOTHY A CARR
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 210-575-0238