Provider Demographics
NPI:1558373712
Name:SPECIALTY UROLOGY, PA
Entity Type:Organization
Organization Name:SPECIALTY UROLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:V
Authorized Official - Last Name:TECUANHUEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-222-2233
Mailing Address - Street 1:343 W HOUSTON ST
Mailing Address - Street 2:801
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2107
Mailing Address - Country:US
Mailing Address - Phone:210-222-2233
Mailing Address - Fax:210-475-9858
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:801
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2107
Practice Address - Country:US
Practice Address - Phone:210-222-2233
Practice Address - Fax:210-475-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81V652OtherBLUE CROSS/BLUE SHIELD
TX083808801Medicaid
TX340007679OtherRAILROAD MEDICARE
TX00L67BMedicare ID - Type Unspecified