Healthcare Provider Details

I. General information

NPI: 1093995508
Provider Name (Legal Business Name): BARLITE SOUTHWEST KIDNEY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 BARLITE BLVD STE 103
SAN ANTONIO TX
78224-1362
US

IV. Provider business mailing address

7500 BARLITE BLVD STE 103
SAN ANTONIO TX
78224-1362
US

V. Phone/Fax

Practice location:
  • Phone: 210-922-3377
  • Fax: 210-922-2311
Mailing address:
  • Phone: 210-922-3377
  • Fax: 210-922-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SZEWE
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 210-922-3377