MEDICARE: PEDIATRIC ORTHOPEDIC ASSOCIATES OF SAN ANTONIO

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	207XP3100X	Pediatric Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	121751506	OTHER	TX	CSHCN

General Provider Information

NPI Number	:	1528003076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC ORTHOPEDIC ASSOCIATES OF SAN ANTONIO

Provider Business Mailing Address
First Line	:	4499 MEDICAL DR.
Second Line	:	SUITE 235
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3712
Country	:	US
Telephone Number	:	210-692-1613
Fax Number	:	210-616-0290

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR.
Second Line	:	SUITE 235
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3712
Country	:	US
Telephone Number	:	210-692-1613
Fax Number	:	210-616-0290

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MR. JOEY WELCH
Credential	:
Telephone Number	:	210-692-1613

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	02/06/2020

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Directions to “PEDIATRIC ORTHOPEDIC ASSOCIATES OF SAN ANTONIO ” Practice Location

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