MEDICARE: METHODIST MEDICAL CENTER ASC LP

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	261QA1903X	Ambulatory Surgical Clinic/Center	007852	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HH031A	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1972570117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	METHODIST MEDICAL CENTER ASC LP

Provider Business Mailing Address
First Line	:	4411 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3822
Country	:	US
Telephone Number	:	210-575-4584
Fax Number	:	210-575-4521

Provider Business Practice Location Address
First Line	:	4411 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3822
Country	:	US
Telephone Number	:	210-575-4584
Fax Number	:	210-575-4521

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. TIMOTHY A CARR
Credential	:
Telephone Number	:	210-575-0238

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	08/22/2020

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Directions to “METHODIST MEDICAL CENTER ASC LP ” Practice Location

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