Provider Demographics
NPI:1639808363
Name:CITY OF SAN ANTONIO TEXAS
Entity Type:Organization
Organization Name:CITY OF SAN ANTONIO TEXAS
Other - Org Name:DISTRICT DIABETES PREVENTION & CONTROL
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING AND CODING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-207-8689
Mailing Address - Street 1:PO BOX 839966
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78283-3966
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 CASTROVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3131
Practice Address - Country:US
Practice Address - Phone:210-207-8802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-08
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare