Provider Demographics
NPI:1093791139
Name:HOLY CROSS FAMILY PRACTICE ASSOCIATION
Entity Type:Organization
Organization Name:HOLY CROSS FAMILY PRACTICE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-433-2334
Mailing Address - Street 1:1511 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-4006
Mailing Address - Country:US
Mailing Address - Phone:210-433-2334
Mailing Address - Fax:210-433-4572
Practice Address - Street 1:1511 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-4006
Practice Address - Country:US
Practice Address - Phone:210-433-2334
Practice Address - Fax:210-433-4572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5129173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111860601Medicaid
TX111860601Medicaid
TX88C568Medicare ID - Type Unspecified