Provider Demographics
NPI:1013383801
Name:SOUTH TEXAS NURSE PRACTITIONER SERVICES, PLLC
Entity Type:Organization
Organization Name:SOUTH TEXAS NURSE PRACTITIONER SERVICES, PLLC
Other - Org Name:INNOVATIVE URGENT CARE & FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHANEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:210-455-6253
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-1678
Mailing Address - Country:US
Mailing Address - Phone:361-438-4000
Mailing Address - Fax:
Practice Address - Street 1:9910 W LOOP 1604 N STE 128
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5610
Practice Address - Country:US
Practice Address - Phone:210-455-6253
Practice Address - Fax:210-455-6287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127362261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370925501Medicaid