Provider Demographics
NPI:1275836835
Name:SAN ANTONIO OSTEO RELIEF CENTER PA
Entity Type:Organization
Organization Name:SAN ANTONIO OSTEO RELIEF CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-545-5128
Mailing Address - Street 1:19016 STONE OAK PKWY
Mailing Address - Street 2:STE 280
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3337
Mailing Address - Country:US
Mailing Address - Phone:210-545-5128
Mailing Address - Fax:210-545-5120
Practice Address - Street 1:19016 STONE OAK PKWY
Practice Address - Street 2:STE 280
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3337
Practice Address - Country:US
Practice Address - Phone:210-545-5128
Practice Address - Fax:210-545-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7262207QG0300X
TXL37782081S0010X
TXK5579332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX319143Medicare PIN
TXTXB125411Medicare PIN
TX6489120001Medicare NSC