Provider Demographics
NPI:1083659866
Name:ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP
Other - Org Name:FOUNDATION SURGERY AFFILIATE OF SAN ANTONIO LP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIR. OF CLINICAL & AMBULATORY SERV
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-253-2662
Mailing Address - Street 1:400 CONCORD PLAZA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6905
Mailing Address - Country:US
Mailing Address - Phone:210-253-2660
Mailing Address - Fax:210-253-2661
Practice Address - Street 1:400 CONCORD PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6905
Practice Address - Country:US
Practice Address - Phone:210-253-2660
Practice Address - Fax:210-253-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007839261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151851601Medicaid
TXHH060AOtherBCBS PROVIDER NUMBER
TXHH060AOtherBCBS PROVIDER NUMBER