MEDICARE: SAN ANTONIO PEDIATRIC PULMONARY & CRITICAL CARE ASSOCIATES

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	2080P0214X	Pediatric Pulmonology Physician	G6858	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1775445005	OTHER	TX	CIGNA
2	2170366	OTHER	TX	AETNA
3	86K911	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1376545624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANTONIO PEDIATRIC PULMONARY & CRITICAL CARE ASSOCIATES

Provider Business Mailing Address
First Line	:	4499 MEDICAL DR
Second Line	:	STE 255
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3757
Country	:	US
Telephone Number	:	210-614-3403
Fax Number	:	210-615-7804

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR
Second Line	:	STE 255
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3757
Country	:	US
Telephone Number	:	210-614-3403
Fax Number	:	210-615-7804

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. MARTHA RUTH MORSE
Credential	:	MD.,F.A.A.P.
Telephone Number	:	210-614-3403

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/22/2020

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Directions to “SAN ANTONIO PEDIATRIC PULMONARY & CRITICAL CARE ASSOCIATES ” Practice Location

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