MEDICARE: THE SAN ANTONIO ORTHOPAEDIC GROUP, LLP

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	208100000X	Physical Medicine & Rehabilitation Physician
2	207XS0106X	Orthopaedic Hand Surgery Physician
3	207XS0117X	Orthopaedic Surgery of the Spine Physician
4	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
5	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician
6	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician
7	261QM1300X	Multi-Specialty Clinic/Center
8	2086S0105X	Surgery of the Hand (Surgery) Physician
9	208VP0000X	Pain Medicine Physician	L2151	TX
10	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ3104	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0005GW	OTHER	TX	BC GROUP #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457429375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SAN ANTONIO ORTHOPAEDIC GROUP, LLP

Provider Business Mailing Address
First Line	:	PO BOX 9585
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-9585
Country	:	US
Telephone Number	:	210-804-5400
Fax Number	:	210-804-6801

Provider Business Practice Location Address
First Line	:	19138 US HIGHWAY 281 N STE 100
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4988
Country	:	US
Telephone Number	:	210-804-5400
Fax Number	:	210-678-4142

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	LAUREN STACEY HARDING
Credential	:
Telephone Number	:	210-804-5911

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	09/03/2025

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