Provider Demographics
NPI:1720223217
Name:WOUND PROFESSIONAL SERVICES OF SAN ANTONIO
Entity Type:Organization
Organization Name:WOUND PROFESSIONAL SERVICES OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANNE
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-807-2589
Mailing Address - Street 1:18407 ROGERS PIKE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4610
Mailing Address - Country:US
Mailing Address - Phone:210-807-2589
Mailing Address - Fax:
Practice Address - Street 1:315 N SAN SABA STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3196
Practice Address - Country:US
Practice Address - Phone:210-704-4300
Practice Address - Fax:210-704-4289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty