Provider Demographics
NPI:1366854168
Name:ORTHOPEDIC & SPINE SURGICAL HOSPITAL OF SOUTH TEXAS, L.P.
Entity Type:Organization
Organization Name:ORTHOPEDIC & SPINE SURGICAL HOSPITAL OF SOUTH TEXAS, L.P.
Other - Org Name:SOUTH TEXAS SPINE & SURGICAL HOSPITAL, L. P.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-507-4091
Mailing Address - Street 1:18600 HARDY OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4206
Mailing Address - Country:US
Mailing Address - Phone:210-404-0800
Mailing Address - Fax:210-404-0802
Practice Address - Street 1:18600 HARDY OAK BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4206
Practice Address - Country:US
Practice Address - Phone:210-404-0800
Practice Address - Fax:210-404-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007868208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158914501Medicaid
TXHH1019OtherBCBS
TX7708368OtherAETNA
TX158914501Medicaid