Provider Demographics
NPI:1386634319
Name:SAN ANTONIO INFECTIOUS DISEASES CONSULTANTS
Entity Type:Organization
Organization Name:SAN ANTONIO INFECTIOUS DISEASES CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-8100
Mailing Address - Street 1:8042 WURZBACH RD STE 280
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3863
Mailing Address - Country:US
Mailing Address - Phone:210-614-8100
Mailing Address - Fax:210-615-7233
Practice Address - Street 1:8042 WURZBACH RD STE 280
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3863
Practice Address - Country:US
Practice Address - Phone:210-614-8100
Practice Address - Fax:210-615-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160073601Medicaid
TX160073601Medicaid