Provider Demographics
NPI:1467824540
Name:PBVDM-HUEBNER, LLC
Entity Type:Organization
Organization Name:PBVDM-HUEBNER, LLC
Other - Org Name:INWOOD EMERGENCY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-445-4450
Mailing Address - Street 1:16403 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1683
Mailing Address - Country:US
Mailing Address - Phone:210-564-9790
Mailing Address - Fax:210-564-9741
Practice Address - Street 1:16403 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1683
Practice Address - Country:US
Practice Address - Phone:210-564-9790
Practice Address - Fax:210-564-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care