Basic Information
| Provider Information | |||||||||
| NPI: | 1649482449 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO, LTD., L.L.P. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | METHODIST HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7700 FLOYD CURL | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105754000 | ||||||||
| FaxNumber: | 2106924410 | ||||||||
| Practice Location | |||||||||
| Address1: | 7700 FLOYD CURL | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105754000 | ||||||||
| FaxNumber: | 2106924410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/31/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BERNAL | ||||||||
| AuthorizedOfficialFirstName: | ENRIQUE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2105756275 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 084667702 | 05 | TX | MEDICAID |