Provider Demographics
NPI:1033591706
Name:UNIVERSITY OF THE INCARNATE WORD
Entity Type:Organization
Organization Name:UNIVERSITY OF THE INCARNATE WORD
Other - Org Name:CARDINAL WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:INSTRUCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:TART
Authorized Official - Last Name:HOOK
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:210-283-6331
Mailing Address - Street 1:4301 BROADWAY ST
Mailing Address - Street 2:CPO 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6318
Mailing Address - Country:US
Mailing Address - Phone:210-283-6331
Mailing Address - Fax:210-829-3174
Practice Address - Street 1:2547 E COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78203-1907
Practice Address - Country:US
Practice Address - Phone:210-283-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX34776302Medicaid