Provider Demographics
NPI:1821021437
Name:SURGICAL PRACTICES OF SOUTH TEXAS, PLLC
Entity Type:Organization
Organization Name:SURGICAL PRACTICES OF SOUTH TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:MATEO
Authorized Official - Last Name:SOULAS
Authorized Official - Suffix:IX
Authorized Official - Credentials:MD
Authorized Official - Phone:210-545-3660
Mailing Address - Street 1:343 W HOUSTON ST
Mailing Address - Street 2:SUITE 705
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2107
Mailing Address - Country:US
Mailing Address - Phone:210-545-3660
Mailing Address - Fax:
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:SUITE 705
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2107
Practice Address - Country:US
Practice Address - Phone:210-545-3660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Not Answered208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicaid
TXPENDINGMedicaid