Provider Demographics
NPI:1619071875
Name:SOUTH TEXAS VETERANS HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:SOUTH TEXAS VETERANS HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR, SOCIAL WORK SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:GROTA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-617-5300
Mailing Address - Street 1:7400 MERTON MINTER BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-617-5300
Mailing Address - Fax:210-949-3326
Practice Address - Street 1:112 DOVE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-7868
Practice Address - Country:US
Practice Address - Phone:830-537-4088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00341OtherSOCIAL WORK LICENSE