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General NPI Number Information
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NPI Number | 1952903197
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Entity Type | Organization
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Legal Business Name | HARDY OAK PVDM ENTERPRISES, LLC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 23511 HARDY OAK BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78258-1928
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Country | US
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Telephone | 210-626-8782
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 690804
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City | SAN ANTONIO
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State | TX
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Zip | 78269-0804
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Country | US
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Telephone | 210-626-8782
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PETER VAN DELDEN
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Credential | MD
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Telephone | 210-373-9647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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