Provider Demographics
NPI:1205089406
Name:PEDIATRIC ANESTHESIA CONSULTANTS OF SAN ANTONIO PLLC
Entity type:Organization
Organization Name:PEDIATRIC ANESTHESIA CONSULTANTS OF SAN ANTONIO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-575-7827
Mailing Address - Street 1:7711 LOUIS PASTEUR DR
Mailing Address - Street 2:STE 708
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3415
Mailing Address - Country:US
Mailing Address - Phone:210-575-7828
Mailing Address - Fax:866-741-3697
Practice Address - Street 1:7700 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3902
Practice Address - Country:US
Practice Address - Phone:210-575-7827
Practice Address - Fax:866-741-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric AnesthesiologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX19779104OtherCSHCN
TX197749801Medicaid
TX197749803Medicaid
TX197749803Medicaid