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General NPI Number Information
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NPI Number | 1619502929
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Entity Type | Organization
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Legal Business Name | SAN ANTONIO WOUND CARE LLC
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Dates
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Enumeration Date | 03/06/2020
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Last Update Date | 01/08/2021
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Provider Practice Location Address
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Address Line | 12501 JUDSON RD STE 102
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City | LIVE OAK
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State | TX
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Zip | 78233-4117
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Country | US
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Telephone | 210-369-9151
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Fax |
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Provider Business Mailing Address
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Address Line | 12501 JUDSON RD STE 102
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City | LIVE OAK
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State | TX
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Zip | 78233-4117
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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 | CLIFFORD CROSSETT
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Credential |
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Telephone | 832-274-6455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0011X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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