Provider Demographics
NPI:1508143777
Name:SPINE & PAIN CENTER OF SAN ANTONIO
Entity Type:Organization
Organization Name:SPINE & PAIN CENTER OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-576-7246
Mailing Address - Street 1:12602 TOEPPERWEIN RD
Mailing Address - Street 2:218
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3269
Mailing Address - Country:US
Mailing Address - Phone:210-615-1901
Mailing Address - Fax:210-615-1905
Practice Address - Street 1:12602 TOEPPERWEIN RD
Practice Address - Street 2:218
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3269
Practice Address - Country:US
Practice Address - Phone:210-615-1901
Practice Address - Fax:210-615-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2023-05-16
Deactivation Date:2023-03-14
Deactivation Code:
Reactivation Date:2023-05-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No3336C0002XSuppliersPharmacyClinic Pharmacy