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General NPI Number Information
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NPI Number | 1225032253
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Entity Type | Organization
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Legal Business Name | KIDNEY TREATMENT CENTER SAN ANTONIO INC
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Dates
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Enumeration Date | 06/08/2005
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 803 CASTROVILLE RD STE 401
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City | SAN ANTONIO
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State | TX
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Zip | 78237-3148
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Country | US
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Telephone | 210-435-4725
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Fax | 210-433-8826
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Provider Business Mailing Address
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Address Line | 3939 MEDICAL DR STE 110 STE 110
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City | SAN ANTONIO
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State | TX
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Zip | 78229-2292
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Country | US
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Telephone | 210-692-1515
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Fax | 210-692-0187
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MRS. JESSICA J MEDOLA
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Credential |
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Telephone | 210-692-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 000043
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License Number State | TX
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