Provider Demographics
NPI:1003935107
Name:SOUTH TEXAS URGENT CARE, PLLC
Entity Type:Organization
Organization Name:SOUTH TEXAS URGENT CARE, PLLC
Other - Org Name:NORTH CENTRAL URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-490-5911
Mailing Address - Street 1:19223 STONEHUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3456
Mailing Address - Country:US
Mailing Address - Phone:210-490-5911
Mailing Address - Fax:210-481-2769
Practice Address - Street 1:19223 STONEHUE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3456
Practice Address - Country:US
Practice Address - Phone:210-490-5911
Practice Address - Fax:210-481-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0036MCOtherBCBS