=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114365681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PULMONOLOGY AND SLEEP SERVICES OF SAN ANTONIO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2013
-----------------------------------------------------
Last Update Date | 07/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11901 TOEPPERWEIN RD STE 1401
-----------------------------------------------------
City | LIVE OAK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-599-1433
-----------------------------------------------------
Fax | 210-599-1803
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11901 TOEPPERWEIN RD STE 1401
-----------------------------------------------------
City | LIVE OAK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-599-1433
-----------------------------------------------------
Fax | 210-599-1803
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL MANAGER
-----------------------------------------------------
Name | MUHAMMAD TALIB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-599-1433
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QS1200X
-----------------------------------------------------
Taxonomy Name | Sleep Disorder Diagnostic Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------