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General NPI Number Information
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NPI Number | 1508288846
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Entity Type | Organization
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Legal Business Name | SOUTH TEXAS SPINE ASC, PLLC
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Dates
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Enumeration Date | 01/06/2014
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Last Update Date | 01/06/2014
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Provider Practice Location Address
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Address Line | 1646 LOCKHILL SELMA RD
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City | SAN ANTONIO
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State | TX
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Zip | 78213-1929
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Country | US
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Telephone | 210-541-0112
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 691223
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City | SAN ANTONIO
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State | TX
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Zip | 78269-1223
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Country | US
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Telephone | 210-773-6655
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN RICHARDSON
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Credential | D.O.
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Telephone | 210-773-6655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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