Basic Information
Provider Information
NPI: 1083883193
EntityType: 2
ReplacementNPI:  
OrganizationName: TOTAL WOUND SPECIALISTS, P.A.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2935 THOUSAND OAKS
Address2: SUITE 294
City: SAN ANTONIO
State: TX
PostalCode: 782473312
CountryCode: US
TelephoneNumber: 2104941100
FaxNumber: 2104941117
Practice Location
Address1: 5101 MEDICAL DR
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782294801
CountryCode: US
TelephoneNumber: 2105925349
FaxNumber: 2105925462
Other Information
ProviderEnumerationDate: 02/22/2008
LastUpdateDate: 06/06/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LARSON-LOHR
AuthorizedOfficialFirstName: VALERIE
AuthorizedOfficialMiddleName: ANN
AuthorizedOfficialTitleorPosition: MANAGING PARTNER
AuthorizedOfficialTelephone: 2104941100
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: APRN
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000XH1292TXY193400000X SINGLE SPECIALTY GROUPOther Service ProvidersSpecialist 

ID Information
IDTypeStateIssuerDescription
15530260105TX MEDICAID
P0009003701TXMEDICAL RAILROADOTHER
87960X01TXBLUE CROSS BLUE SHIELDOTHER
G2568401TXUPINOTHER


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