MEDICARE: WESTOVER HILLS 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	202K00000X	Phlebology Physician	H8107	TX
2	2086S0129X	Vascular Surgery Physician	H8107	TX
3	208600000X	Surgery Physician	H8107	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0052QH	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1952590390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTOVER HILLS SURGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	3903 WISEMAN BLVD
Second Line	:	STE 304
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4401
Country	:	US
Telephone Number	:	210-521-1987
Fax Number	:	210-521-1927

Provider Business Practice Location Address
First Line	:	3903 WISEMAN BLVD
Second Line	:	STE 304
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4401
Country	:	US
Telephone Number	:	210-521-1987
Fax Number	:	210-521-1927

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY HAMON
Credential	:	M.D.
Telephone Number	:	210-479-5784

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	06/30/2008

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