Provider Demographics
NPI:1780015719
Name:RHEUMATOLOGY ASSOCIATES OF SOUTH TEXAS, PLLC
Entity Type:Organization
Organization Name:RHEUMATOLOGY ASSOCIATES OF SOUTH TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-448-4344
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78293
Mailing Address - Country:US
Mailing Address - Phone:210-448-4344
Mailing Address - Fax:210-448-4347
Practice Address - Street 1:3903 WISEMAN BLVD
Practice Address - Street 2:STE 221
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4401
Practice Address - Country:US
Practice Address - Phone:210-448-4344
Practice Address - Fax:210-448-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W639OtherMEDICARE PTAN
TX6924760001Medicare NSC