Provider Demographics
NPI:1164533816
Name:BEXAR COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:BEXAR COUNTY HOSPITAL DISTRICT
Other - Org Name:UNIVERSITY HEALTH- SE FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CPO/SVP PHARMACOTHERAPY & PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MBA, RPH
Authorized Official - Phone:210-743-4022
Mailing Address - Street 1:4502 MEDICAL DR # MS 102-1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4402
Mailing Address - Country:US
Mailing Address - Phone:210-743-4022
Mailing Address - Fax:210-702-4066
Practice Address - Street 1:1055 ADA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1703
Practice Address - Country:US
Practice Address - Phone:210-358-5534
Practice Address - Fax:210-358-5505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEXAR COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4590104OtherNCPDP# (NABP#)
TX250387Medicaid
TX250387Medicaid