MEDICARE: UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	2085P0229X	Pediatric Radiology Physician
2	2085R0204X	Vascular & Interventional Radiology Physician
3	2085B0100X	Body Imaging Physician
4	2085R0202X	Diagnostic Radiology Physician	TX

General Provider Information

NPI Number	:	1417921834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO

Provider Business Mailing Address
First Line	:	8431 FREDERICKSBURG RD FL 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3392
Country	:	US
Telephone Number	:	210-450-9000
Fax Number	:	210-450-4903

Provider Business Practice Location Address
First Line	:	25753 OLD FREDERICKSBURG
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78015
Country	:	US
Telephone Number	:	210-450-9000
Fax Number	:

Authorized Official
Title or Position	:	VP OF BUSINESS AFFAIRS
Name	:	ANDREA S. MARKS
Credential	:	M.B.A., C.P.A.
Telephone Number	:	210-567-7020

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	09/30/2025

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