| |
540 Madison Oak Ste 140, San Antonio, TX 78258-3919 | |
(210) 495-0086 | |
(210) 495-0801 |
Full Name | |
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Type | Facility |
Speciality | Anesthesiology - Pain Medicine |
Location | 540 Madison Oak Ste 140, San Antonio, Texas |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1609178292 | NPI | - | NPPES |
F9289 | Other | TN | STATE LICENSE |
1477525533 | Other | TX | NPI |
603040 | Medicaid | TX | |
5019 | Other | TX | STATE LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 5019 (Texas) | Secondary |
207LP2900X | Anesthesiology - Pain Medicine | F9289 (Texas) | Primary |
Mailing Address | Practice Location Address |
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540 Madison Oak Ste 140, San Antonio, TX 78258-3919 Ph: (210) 495-0086 | 540 Madison Oak Ste 140, San Antonio, TX 78258-3919 Ph: (210) 495-0086 |