=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003908807
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLANNED PARENTHOOD SOUTH TEXAS SURGICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2006
-----------------------------------------------------
Last Update Date | 08/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2140 BABCOCK
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-681-7800
-----------------------------------------------------
Fax | 210-521-6872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2140 BABCOCK
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-572-5302
-----------------------------------------------------
Fax | 210-521-6872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE CHAIR SECRETARY
-----------------------------------------------------
Name | MRS. POLIN C BARRAZA
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 210-575-5287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA0005X
-----------------------------------------------------
Taxonomy Name | Ambulatory Family Planning Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QA0005X
-----------------------------------------------------
Taxonomy Name | Ambulatory Family Planning Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 130241
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 261QF0050X
-----------------------------------------------------
Taxonomy Name | Non-Surgical Family Planning Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------