Provider Demographics
NPI:1417951237
Name:SAN ANTONIO ORTHOTICS CORPORATION
Entity Type:Organization
Organization Name:SAN ANTONIO ORTHOTICS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LO,BOCO,CO
Authorized Official - Phone:210-614-8777
Mailing Address - Street 1:7220 LOUIS PASTEUR
Mailing Address - Street 2:STE 144
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4535
Mailing Address - Country:US
Mailing Address - Phone:210-614-8777
Mailing Address - Fax:210-614-8795
Practice Address - Street 1:7220 LOUIS PASTEUR
Practice Address - Street 2:STE 144
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4535
Practice Address - Country:US
Practice Address - Phone:210-614-8777
Practice Address - Fax:210-614-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000153335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0107799-01Medicaid
TX1230140001Medicare ID - Type Unspecified7220 LOUIS PASTEUR #150