Provider Demographics
NPI:1407612518
Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Entity Type:Organization
Organization Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Other - Org Name:UT HEALTH KSP DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FOR BUSINESS AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPA
Authorized Official - Phone:210-450-9000
Mailing Address - Street 1:7946 N. LOOP 1604 WEST
Mailing Address - Street 2:1ST FLOOR RM 131
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249
Mailing Address - Country:US
Mailing Address - Phone:210-567-9040
Mailing Address - Fax:
Practice Address - Street 1:7946 N. LOOP 1604 WEST
Practice Address - Street 2:1ST FLOOR RM 131
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-567-9040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier