Provider Demographics
NPI:1376164475
Name:ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP
Entity Type:Organization
Organization Name:ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP
Other - Org Name:RIDGEWOOD ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF AMBULATORY SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-489-7278
Mailing Address - Street 1:19138 N US HWY 281
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4988
Mailing Address - Country:US
Mailing Address - Phone:210-253-2660
Mailing Address - Fax:210-253-2661
Practice Address - Street 1:19138 N US HWY 281
Practice Address - Street 2:STE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4988
Practice Address - Country:US
Practice Address - Phone:210-253-2660
Practice Address - Fax:210-253-2661
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC SURGERY CENTER OF SAN ANTONIO LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-29
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical