Provider Demographics
NPI:1376545624
Name:SAN ANTONIO PEDIATRIC PULMONARY & CRITICAL CARE ASSOCIATES
Entity Type:Organization
Organization Name:SAN ANTONIO PEDIATRIC PULMONARY & CRITICAL CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD,FAAP
Authorized Official - Phone:210-614-3403
Mailing Address - Street 1:4499 MEDICAL DR
Mailing Address - Street 2:STE 255
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3757
Mailing Address - Country:US
Mailing Address - Phone:210-614-3403
Mailing Address - Fax:210-615-7804
Practice Address - Street 1:4499 MEDICAL DR
Practice Address - Street 2:STE 255
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3757
Practice Address - Country:US
Practice Address - Phone:210-614-3403
Practice Address - Fax:210-615-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG68582080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1775445005OtherCIGNA
TX2170366OtherAETNA
TX86K911OtherBCBS
TX1775445005OtherCIGNA