Basic Information
| Provider Information | |||||||||
| NPI: | 1932284411 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOUNDATION BARIATRIC HOSPITAL OF SAN ANTONIO, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FOUNDATION SURGICAL HOSPITAL OF SAN ANTONIO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15305 DALLAS PKWY STE 1600 | ||||||||
| Address2: | |||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750016491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727633893 | ||||||||
| FaxNumber: | 9726926745 | ||||||||
| Practice Location | |||||||||
| Address1: | 9522 HUEBNER RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782401548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104785400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | MORAN | ||||||||
| AuthorizedOfficialFirstName: | JENETHA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER / AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9727633893 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.