Provider Demographics
NPI:1386657047
Name:THEDA OAKS GASTROENTEROLOGY & ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:THEDA OAKS GASTROENTEROLOGY & ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3890
Mailing Address - Street 1:19226 STONE HUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-268-0100
Mailing Address - Fax:210-268-0150
Practice Address - Street 1:19226 STONEHUE STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3480
Practice Address - Country:US
Practice Address - Phone:210-268-0100
Practice Address - Fax:210-268-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008032261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167223001Medicaid
ASC208Medicare PIN