Provider Demographics
NPI:1376733519
Name:METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO LTD LLP
Entity Type:Organization
Organization Name:METHODIST HEALTHCARE SYSTEM OF SAN ANTONIO LTD LLP
Other - Org Name:NORTHEAST METHODIST HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-646-5000
Mailing Address - Street 1:12412 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3255
Mailing Address - Country:US
Mailing Address - Phone:210-650-4949
Mailing Address - Fax:210-646-5038
Practice Address - Street 1:12412 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3255
Practice Address - Country:US
Practice Address - Phone:210-650-4949
Practice Address - Fax:210-646-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N92JMedicare PIN