Basic Information
| Provider Information | |||||||||
| NPI: | 1780681189 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN ANTONIO REGIONAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 SAN BERNARDINO RD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099852811 | ||||||||
| FaxNumber: | 9099491774 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 SAN BERNARDINO RD | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099852811 | ||||||||
| FaxNumber: | 9099491774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 02/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | HSU | ||||||||
| AuthorizedOfficialFirstName: | WAH-CHUNG | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | V.P. FINANCE/CFO | ||||||||
| AuthorizedOfficialTelephone: | 9099206103 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 240000196 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | ZZT40099F(OP) | 01 | MEDICAID | OTHER | ZZT30099F (IP) | 01 | MEDICAID | OTHER |