Provider Demographics
NPI:1689991978
Name:WOUND PROFESSIONAL SERVICES OF SAN ANTONIO PA
Entity Type:Organization
Organization Name:WOUND PROFESSIONAL SERVICES OF SAN ANTONIO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:PS
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-807-2589
Mailing Address - Street 1:PO BOX 781652
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-1652
Mailing Address - Country:US
Mailing Address - Phone:210-807-2589
Mailing Address - Fax:
Practice Address - Street 1:3635 CYPRESS CPE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2379
Practice Address - Country:US
Practice Address - Phone:210-807-2589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty