Provider Demographics
NPI:1003908807
Name:PLANNED PARENTHOOD SOUTH TEXAS SURGICAL CENTER
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD SOUTH TEXAS SURGICAL CENTER
Other - Org Name:PLANNED PARENTHOOD SEXUAL HEALTHCARE SERVICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE CHAIR SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:POLIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARRAZA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:210-575-5287
Mailing Address - Street 1:2140 BABCOCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-572-5302
Mailing Address - Fax:210-521-6872
Practice Address - Street 1:2140 BABCOCK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-681-7800
Practice Address - Fax:210-521-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X, 261QA0005X, 261QF0050X
TX261QA0005X
TX130241261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137339110Medicaid