Provider Demographics
NPI:1578973863
Name:DANA L. REISS, MD, PLLC
Entity Type:Organization
Organization Name:DANA L. REISS, MD, PLLC
Other - Org Name:SURGICAL CONSULTANTS OF SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER REALTIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-508-6214
Mailing Address - Street 1:9150 HUEBNER RD
Mailing Address - Street 2:250
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1558
Mailing Address - Country:US
Mailing Address - Phone:210-614-9210
Mailing Address - Fax:210-614-6859
Practice Address - Street 1:9150 HUEBNER RD
Practice Address - Street 2:250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1558
Practice Address - Country:US
Practice Address - Phone:210-614-9210
Practice Address - Fax:210-614-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0538174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047479302Medicaid