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General NPI Number Information
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NPI Number | 1396048674
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Entity Type | Organization
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Legal Business Name | PROSTHETIC SCIENCE SAN ANTONIO INC
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 4242 MEDICAL DR STE 7275
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5640
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Country | US
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Telephone | 210-949-0488
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Fax | 210-949-0499
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Provider Business Mailing Address
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Address Line | 4242 MEDICAL DR STE 7275
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5640
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Country | US
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Telephone | 210-949-0488
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Fax | 210-949-0499
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Authorized Official
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Title or Position | PRACTITIONER IN CHARGE
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Name | JULIE HOLLIMON
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Credential | CP
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Telephone | 210-393-4796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 101348
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License Number State | TX
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