Provider Demographics
NPI:1821274689
Name:SAN ANTONIO EPA, PA
Entity Type:Organization
Organization Name:SAN ANTONIO EPA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACEP
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-495-9860
Mailing Address - Street 1:8401 DATAPOINT DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5907
Mailing Address - Country:US
Mailing Address - Phone:210-614-0180
Mailing Address - Fax:210-566-2063
Practice Address - Street 1:111 DALLAS ST
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1201
Practice Address - Country:US
Practice Address - Phone:210-297-7000
Practice Address - Fax:210-566-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192644601Medicaid
TX192644601Medicaid