MEDICARE: BEXAR COUNTY HOSPITAL DISTRICT

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1811320948
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEXAR COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	4502 MEDICAL DRIVE
Second Line	:	MAIL STOP 84-1
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4493
Country	:	US
Telephone Number	:	210-358-0663
Fax Number	:	210-358-1855

Provider Business Practice Location Address
First Line	:	4502 MEDICAL DRIVE
Second Line	:	MAIL STOP 92-1
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4493
Country	:	US
Telephone Number	:	210-358-9209
Fax Number	:	210-358-9116

Authorized Official
Title or Position	:	EXECUTIVE VICE PRESIDENT/CFO
Name	:	MR. REED HURLEY
Credential	:
Telephone Number	:	210-358-2101

Provider Enumeration Date	:	08/13/2013
Last Update Date	:	06/18/2015

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