Provider Demographics
NPI:1033246418
Name:UNIVERSITY HEALTH SYSTEM - KENWOOD CLINIC
Entity Type:Organization
Organization Name:UNIVERSITY HEALTH SYSTEM - KENWOOD CLINIC
Other - Org Name:UNIVERSITY HEALTH SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DATA SECURITY ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:210-358-2000
Mailing Address - Street 1:4502 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4402
Mailing Address - Country:US
Mailing Address - Phone:210-358-2000
Mailing Address - Fax:210-358-4745
Practice Address - Street 1:302 DORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1516
Practice Address - Country:US
Practice Address - Phone:210-736-1536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEXAR COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126881507Medicaid
TX107603609Medicaid