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General NPI Number Information
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NPI Number | 1366767196
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Entity Type | Organization
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Legal Business Name | TIAMAT ENTERPRISES, INC.
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 5555 N LAMAR BLVD STE L101
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City | AUSTIN
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State | TX
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Zip | 78751-1066
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Country | US
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Telephone | 512-310-2273
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Fax | 866-517-4896
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Provider Business Mailing Address
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Address Line | 201 E PARK AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4657
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY ADAM SALTER
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Credential |
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Telephone | 210-757-4650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 010853
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License Number State | TX
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