=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073558912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTUS SANTA ROSA SURGERY CENTER L.L.P.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2006
-----------------------------------------------------
Last Update Date | 06/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2833 BABCOCK RD TOWER II, SUITE 100
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-5390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-293-4400
-----------------------------------------------------
Fax | 210-568-6597
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2833 BABCOCK RD TOWER II, SUITE 100
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-5390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-293-4400
-----------------------------------------------------
Fax | 210-568-6597
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS OFFICE MANAGER
-----------------------------------------------------
Name | MS. TERESA GRAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-293-4400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 008059
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------