Healthcare Provider Details

I. General information

NPI: 1073574505
Provider Name (Legal Business Name): ACCORD MEDICAL MANAGEMENT, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 VANCE JACKSON RD
SAN ANTONIO TX
78230-5321
US

IV. Provider business mailing address

414 NAVARRO ST SUITE 600
SAN ANTONIO TX
78205-2516
US

V. Phone/Fax

Practice location:
  • Phone: 210-271-2188
  • Fax: 210-271-2023
Mailing address:
  • Phone: 210-271-2188
  • Fax: 210-271-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number000396
License Number StateTX

VIII. Authorized Official

Name: MR. LESTER E SURROCK
Title or Position: SENIOR VICE PRESIDENT AND CFO
Credential: CPA
Phone: 210-271-2190