Provider Demographics
NPI:1326342015
Name:B.S.ATHREYA,M.D.,P.A.& ASSOCIATES
Entity Type:Organization
Organization Name:B.S.ATHREYA,M.D.,P.A.& ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAKTHAVATHSALAM
Authorized Official - Middle Name:SWAMYNATHAN
Authorized Official - Last Name:ATHREYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-225-4641
Mailing Address - Street 1:215.EAST QUINCY STREET. SUITE # 430
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215
Mailing Address - Country:US
Mailing Address - Phone:210-225-4641
Mailing Address - Fax:210-226-3610
Practice Address - Street 1:215 E QUINCY ST STE 430
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2034
Practice Address - Country:US
Practice Address - Phone:210-225-4641
Practice Address - Fax:210-226-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4520207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123985703Medicaid
TX123985703Medicaid