Provider Demographics
NPI:1841740438
Name:SAN ANTONIO MEDICAL CENTER
Entity Type:Organization
Organization Name:SAN ANTONIO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANBANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-666-5116
Mailing Address - Street 1:1701 S FEDERAL BLVD # D
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-4898
Mailing Address - Country:US
Mailing Address - Phone:303-936-1760
Mailing Address - Fax:303-934-4036
Practice Address - Street 1:1701 S FEDERAL BLVD # D
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-4898
Practice Address - Country:US
Practice Address - Phone:303-936-1760
Practice Address - Fax:303-934-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0054747261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care