Provider Demographics
NPI:1245566207
Name:SOUTH TEXAS HEALTH ALLIANCE
Entity Type:Organization
Organization Name:SOUTH TEXAS HEALTH ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BOARD OF DIRECTORS
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKULECKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-277-2208
Mailing Address - Street 1:1700 WEST LOOP SOUTH
Mailing Address - Street 2:STE 400B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-3005
Mailing Address - Country:US
Mailing Address - Phone:713-277-2700
Mailing Address - Fax:
Practice Address - Street 1:315 N SAN SABA
Practice Address - Street 2:SUITE 1195
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3154
Practice Address - Country:US
Practice Address - Phone:210-886-8340
Practice Address - Fax:210-886-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5680Medicare PIN