Healthcare Provider Details

I. General information

NPI: 1538224142
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: 12/26/2006
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S. ZARZAMORA FLOOR 2 - RM 2120
SAN ANTONIO TX
78207
US

IV. Provider business mailing address

8431 FREDERICKSBURG RD FL 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 Number101088
License Number StateTX

VIII. Authorized Official

Name: ANDREA MARKS
Title or Position: VP & CHIEF FINANCIAL OFFICER
Credential:
Phone: 210-450-4621