Basic Information
| Provider Information | |||||||||
| NPI: | 1124074273 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., L.L.P. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | METHODIST HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7700 FLOYD CURL DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105754000 | ||||||||
| FaxNumber: | 2106924410 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 FLOYD CURL DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105754000 | ||||||||
| FaxNumber: | 2106924410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BERNAL | ||||||||
| AuthorizedOfficialFirstName: | ENRIQUE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2105756275 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1757802 | 05 | LA | MEDICAID | 450388 | 01 | WORKMANS COMP | OTHER | 5000178 | 01 | UNITED HEALTHCARE | OTHER | 450388 | 01 | UNICARE | OTHER | 80538400 | 05 | WI | MEDICAID | 95006904 | 05 | CO | MEDICAID | 000045721 | 01 | HUMANA | OTHER | 236556700 | 01 | US DEPT OF LABOR | OTHER | 092621300 | 05 | FL | MEDICAID | 148116105 | 05 | AR | MEDICAID | 300188 | 01 | BLACK LUNG | OTHER | 100701670A | 05 | OK | MEDICAID | 450388 | 01 | STERLING OPTION | OTHER | HH1557 | 01 | TX | BLUE CROSS | OTHER | 94154402 | 05 | TX | MEDICAID | 0068137 | 01 | AETNA/US HEALTHCARE | OTHER | 3341320 | 01 | HEALTHMARKET | OTHER | XHSP42561 | 05 | CA | MEDICAID |