Provider Demographics
NPI:1619265220
Name:ACORN PEDIATRICS OF SAN ANTONIO
Entity Type:Organization
Organization Name:ACORN PEDIATRICS OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOURLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-697-2400
Mailing Address - Street 1:PO BOX 781876
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-1876
Mailing Address - Country:US
Mailing Address - Phone:210-697-2400
Mailing Address - Fax:210-697-2401
Practice Address - Street 1:15303 HUEBNER RD
Practice Address - Street 2:# 9
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0959
Practice Address - Country:US
Practice Address - Phone:210-697-2400
Practice Address - Fax:210-697-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-17
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty