=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700895539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUDIE L MURPHY VETERANS MEMORIAL HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7400 MERTON MINTER BLVD DEPT. OF ORTHOPEDICS
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-617-5101
-----------------------------------------------------
Fax | 210-617-5349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7400 MERTON MINTER BLVD DEPT. OF ORTHOPEDICS
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-617-5101
-----------------------------------------------------
Fax | 210-617-5349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OF STAFF
-----------------------------------------------------
Name | DR. RICHARD BAUER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 210-617-5104
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number | PA03012
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------