Provider Demographics
NPI:1114609872
Name:HOSPITAL SAN ANTONIO
Entity Type:Organization
Organization Name:HOSPITAL SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR GENERAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-988-6512
Mailing Address - Street 1:5219 MCPHERSON RD STE 430
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-7306
Mailing Address - Country:US
Mailing Address - Phone:619-988-6512
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA ORIENTE HIDALGO NO 23
Practice Address - Street 2:SAN ANTONIO TLAYACAPAN
Practice Address - City:AJIJIC
Practice Address - State:JALISCO
Practice Address - Zip Code:45922
Practice Address - Country:MX
Practice Address - Phone:376-689-0911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital