Provider Demographics
NPI:1538304043
Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Other - Org Name:CANCER THERAPY AND RESEARCH CENTER LAB AT THE UT HEALTH SCIENCE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & CFO BUS AFFAIRS
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPA
Authorized Official - Phone:210-567-7020
Mailing Address - Street 1:6126 WURZBACH RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1743
Mailing Address - Country:US
Mailing Address - Phone:210-257-1500
Mailing Address - Fax:210-527-1421
Practice Address - Street 1:7979 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4427
Practice Address - Country:US
Practice Address - Phone:210-450-5782
Practice Address - Fax:210-949-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0898964291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory