Healthcare Provider Details

I. General information

NPI: 1114024718
Provider Name (Legal Business Name): UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DRIVE 6TH FLOOR - 638E
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

8431 FREDERICKSBURG ROAD FLOOR 1
SAN ANTONIO TX
78229-3392
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-6470
  • Fax: 210-200-6315
Mailing address:
  • Phone: 210-450-9000
  • Fax: 210-450-4903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number101005
License Number StateTX

VIII. Authorized Official

Name: ANDREA MARKS
Title or Position: VP & CFO
Credential:
Phone: 210-450-4621