Provider Demographics
NPI:1184615932
Name:ALAMO HEIGHTS SURGICARE LP
Entity type:Organization
Organization Name:ALAMO HEIGHTS SURGICARE LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3859
Mailing Address - Street 1:5307 BROADWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5724
Mailing Address - Country:US
Mailing Address - Phone:210-826-7366
Mailing Address - Fax:210-826-5804
Practice Address - Street 1:5307 BROADWAY
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5724
Practice Address - Country:US
Practice Address - Phone:210-826-7366
Practice Address - Fax:210-826-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008174261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750689-01Medicaid
TXHH1517OtherBLUE CROSS BLUE SHIELD
TX45C0001263Medicare Oscar/Certification
TXHH1517OtherBLUE CROSS BLUE SHIELD