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General NPI Number Information
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NPI Number | 1609178292
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Entity Type | Organization
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Legal Business Name | EC PA
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Dates
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Enumeration Date | 12/02/2010
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 540 MADISON OAK STE 140
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3919
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Country | US
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Telephone | 210-495-0086
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Fax | 210-495-0801
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Provider Business Mailing Address
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Address Line | 540 MADISON OAK STE 140
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3919
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Country | US
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Telephone | 210-495-0086
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Fax | 210-495-0801
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Authorized Official
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Title or Position | M.D./ PRESIDENT
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Name | DR. EDDIE L CERDAY
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Credential | M.D.
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Telephone | 210-495-0086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5019
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | F9289
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License Number State | TX
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