Provider Demographics
NPI:1578686192
Name:SAN ANTONIO HORIZON HILLS LLC
Entity Type:Organization
Organization Name:SAN ANTONIO HORIZON HILLS LLC
Other - Org Name:CASTLE HILLS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-342-7300
Mailing Address - Street 1:2108 NW MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1882
Mailing Address - Country:US
Mailing Address - Phone:210-342-7300
Mailing Address - Fax:
Practice Address - Street 1:2108 NW MILITARY HWY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1882
Practice Address - Country:US
Practice Address - Phone:210-342-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0017EMOtherBCBS
TX081079801Medicaid
TX081079801Medicaid