=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154369114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTUS SANTA ROSA PASC-SAN ANTONIO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2006
-----------------------------------------------------
Last Update Date | 05/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 423 TREELINE PARK STE 202
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78209-2078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-949-6000
-----------------------------------------------------
Fax | 210-949-6099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 NE LOOP 410 STE 475
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78216-4720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-805-3203
-----------------------------------------------------
Fax | 210-824-3092
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GARY K RUFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 469-282-2637
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------