Provider Demographics
NPI:1780183590
Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Other - Org Name:UT HEALTH ORTHOPAEDIC - MARC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-450-4621
Mailing Address - Street 1:8431 FREDERICKSBURG RD FL 5
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3392
Mailing Address - Country:US
Mailing Address - Phone:210-450-9300
Mailing Address - Fax:210-450-6023
Practice Address - Street 1:8300 FLOYD CURL DR FL 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9300
Practice Address - Fax:210-450-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX406402401Medicaid
TX406402402OtherCSHCN