Basic Information
| Provider Information | |||||||||
| NPI: | 1871560003 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO LTD LLP | ||||||||
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| OtherOrganizationName: | METHODIST AMBULATORY SURGERY HOSPITAL, NORTHWEST. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9150 HUEBNER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105755000 | ||||||||
| FaxNumber: | 2105755080 | ||||||||
| Practice Location | |||||||||
| Address1: | 9150 HUEBNER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105755000 | ||||||||
| FaxNumber: | 2105755080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | CARR | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2105750238 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 000681 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 282N00000X | 000681 | TX | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 121820803 | 05 | TX | MEDICAID | HH0913 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 121820802 | 05 | TX | MEDICAID |