=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780708016
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH TEXAS WOUND ASSOCIATES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2007
-----------------------------------------------------
Last Update Date | 01/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8811 VILLAGE DR NEB WOUND HEALING CENTER
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78217-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-297-2520
-----------------------------------------------------
Fax | 210-297-2539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 780764
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78278-0764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-289-5948
-----------------------------------------------------
Fax | 210-408-0117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JAYESH SHAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 210-297-2520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------