MEDICARE: CHRISTUS SANTA ROSA PASC-SAN ANTONIO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1154369114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTUS SANTA ROSA PASC-SAN ANTONIO LLC

Provider Business Mailing Address
First Line	:	100 NE LOOP 410 STE 475
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-4720
Country	:	US
Telephone Number	:	210-805-3203
Fax Number	:	210-824-3092

Provider Business Practice Location Address
First Line	:	423 TREELINE PARK STE 202
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2078
Country	:	US
Telephone Number	:	210-949-6000
Fax Number	:	210-949-6099

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY K RUFF
Credential	:
Telephone Number	:	469-282-2637

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	05/11/2022

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