Basic Information
| Provider Information | |||||||||
| NPI: | 1336551126 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UROLOGY SAN ANTONIO PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7909 FREDERICKSBURG RD | ||||||||
| Address2: | STE 110 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106144544 | ||||||||
| FaxNumber: | 2106793720 | ||||||||
| Practice Location | |||||||||
| Address1: | 18915 MEISNER DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782584223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104995158 | ||||||||
| FaxNumber: | 2106793730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2014 | ||||||||
| LastUpdateDate: | 09/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | VASSAR | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2107312050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | G8179 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology | 332B00000X | G8179 | TX | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 084053002 | 05 | TX | MEDICAID |