Provider Demographics
NPI: | 1376501668 |
---|---|
Name: | TEXAS INSTITUTE OF MEDICINE AND SURGERY |
Entity Type: | Organization |
Organization Name: | TEXAS INSTITUTE OF MEDICINE AND SURGERY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | COO |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | ROBERTA |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | CLOUD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 210-575-8500 |
Mailing Address - Street 1: | 7711 LOUIS PASTEUR DR |
Mailing Address - Street 2: | SUITE 707 |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78229-3415 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-575-6755 |
Mailing Address - Fax: | 210-575-6902 |
Practice Address - Street 1: | 7711 LOUIS PASTEUR DR |
Practice Address - Street 2: | SUITE 707 |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78229-3415 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-575-6755 |
Practice Address - Fax: | 210-575-6902 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-03 |
Last Update Date: | 2008-11-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
No | 207RI0008X | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | Group - Multi-Specialty |
No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Multi-Specialty | |
No | 364SN0800X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Neuroscience | Group - Multi-Specialty |
No | 364SP0200X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Pediatrics | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 083784102 | Medicaid | |
TX | CG5475 | Other | MEDICARE RAILROAD |
TX | CG5475 | Other | MEDICARE RAILROAD |