MEDICARE: SOUTH TEXAS MEDICAL CENTER

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	173000000X	Legal Medicine	J4593	TX

General Provider Information

NPI Number	:	1427183987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2506 S LANCASTER RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-2532
Country	:	US
Telephone Number	:	214-374-2880
Fax Number	:	214-374-2853

Provider Business Practice Location Address
First Line	:	2506 S LANCASTER RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-2532
Country	:	US
Telephone Number	:	214-374-2880
Fax Number	:	214-374-2853

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JILL WAGGONER
Credential	:	M.D.
Telephone Number	:	214-374-2880

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/22/2020

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Directions to “SOUTH TEXAS MEDICAL CENTER ” Practice Location

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