Provider Demographics
NPI:1609178292
Name:EC PA
Entity Type:Organization
Organization Name:EC PA
Other - Org Name:SCULPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D./ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CERDAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-495-0086
Mailing Address - Street 1:540 MADISON OAK STE 140
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3919
Mailing Address - Country:US
Mailing Address - Phone:210-495-0086
Mailing Address - Fax:210-495-0801
Practice Address - Street 1:540 MADISON OAK STE 140
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3919
Practice Address - Country:US
Practice Address - Phone:210-495-0086
Practice Address - Fax:210-495-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5019111N00000X
TXF9289207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF9289OtherSTATE LICENSE
TX1477525533OtherNPI
TX603040Medicaid
TX5019OtherSTATE LICENSE
TXT85078Medicare UPIN