Provider Demographics
NPI:1093835456
Name:SOUTH ALAMO NEURO DIAGNOSTIC
Entity Type:Organization
Organization Name:SOUTH ALAMO NEURO DIAGNOSTIC
Other - Org Name:SANDAL MONITORING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:LUTHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-8460
Mailing Address - Street 1:8460 FREDERICKSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3317
Mailing Address - Country:US
Mailing Address - Phone:210-614-8460
Mailing Address - Fax:210-614-8461
Practice Address - Street 1:8460 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3317
Practice Address - Country:US
Practice Address - Phone:210-614-8460
Practice Address - Fax:210-614-8461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTS239Medicare PIN