Provider Demographics
NPI:1235399858
Name:STEVEN W FATH MD
Entity Type:Organization
Organization Name:STEVEN W FATH MD
Other - Org Name:GUADALUPE VALLEY SURGICAL ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-733-1802
Mailing Address - Street 1:1346 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5126
Mailing Address - Country:US
Mailing Address - Phone:830-303-8600
Mailing Address - Fax:830-303-8601
Practice Address - Street 1:1346 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5126
Practice Address - Country:US
Practice Address - Phone:830-303-8600
Practice Address - Fax:830-303-8601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8144174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0048HZOtherBLUE CROSS
TX0048HZOtherBLUE CROSS GROUP