Provider Demographics
NPI:1467448373
Name:SOUTH CENTRAL TEXAS BONE AND JOINT CENTER, PA
Entity Type:Organization
Organization Name:SOUTH CENTRAL TEXAS BONE AND JOINT CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-200-1874
Mailing Address - Street 1:1711 W WHEELER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ARANSAS PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78336-4536
Mailing Address - Country:US
Mailing Address - Phone:361-226-3434
Mailing Address - Fax:210-978-5480
Practice Address - Street 1:1711 W WHEELER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4536
Practice Address - Country:US
Practice Address - Phone:361-226-3434
Practice Address - Fax:210-978-5480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00235ZMedicare ID - Type Unspecified