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General NPI Number Information
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NPI Number | 1093835456
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Entity Type | Organization
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Legal Business Name | SOUTH ALAMO NEURO DIAGNOSTIC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 8460 FREDERICKSBURG RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3317
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Country | US
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Telephone | 210-614-8460
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Fax | 210-614-8461
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Provider Business Mailing Address
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Address Line | 8460 FREDERICKSBURG RD
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City | SAN ANTONIO
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State | TX
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Zip | 78229-3317
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Country | US
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Telephone | 210-614-8460
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Fax | 210-614-8461
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Authorized Official
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Title or Position | CFO
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Name | J SCOTT LUTHER
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Credential | MD
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Telephone | 210-614-8460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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