Provider Demographics
NPI:1639114275
Name:COLON & RECTAL SURGICAL ASSOCIATES OF SAN ANTONIO, P.A.
Entity Type:Organization
Organization Name:COLON & RECTAL SURGICAL ASSOCIATES OF SAN ANTONIO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-614-0892
Mailing Address - Street 1:7950 FLOYD CURL DR
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3919
Mailing Address - Country:US
Mailing Address - Phone:210-614-0880
Mailing Address - Fax:210-692-0301
Practice Address - Street 1:7950 FLOYD CURL DR
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3916
Practice Address - Country:US
Practice Address - Phone:210-614-0880
Practice Address - Fax:210-692-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00TS98174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00TS98OtherMEDICARE GROUP #
TX085514001Medicaid