MEDICARE: SAN ANTONIO HEAD & NECK SURGICAL 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	174400000X	Specialist

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

General Provider Information

NPI Number	:	1790168417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANTONIO HEAD & NECK SURGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	926 BOOKLYN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1637
Country	:	US
Telephone Number	:	210-616-0283
Fax Number	:	210-616-0071

Provider Business Practice Location Address
First Line	:	926 BOOKLYN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1637
Country	:	US
Telephone Number	:	210-616-0283
Fax Number	:	210-616-0071

Authorized Official
Title or Position	:	CREDENTIALER
Name	:	TRACY GIBSON
Credential	:
Telephone Number	:	210-616-0283

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/30/2015

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Directions to “SAN ANTONIO HEAD & NECK SURGICAL ASSOCIATES ” Practice Location

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