=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932854809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN ANTONIO FERTILITY SURGERY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2022
-----------------------------------------------------
Last Update Date | 02/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18707 HARDY OAK BLVD STE 505
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-4891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-370-3800
-----------------------------------------------------
Fax | 210-370-3005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6500 N MOPAC EXPY BLDG I
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78731-3282
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-451-0149
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. ERIKA MUNCH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 210-370-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0006X
-----------------------------------------------------
Taxonomy Name | Ambulatory Fertility Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------