Provider Demographics
NPI:1205212313
Name:PRESTIGE EMERGENCY ROOM
Entity type:Organization
Organization Name:PRESTIGE EMERGENCY ROOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERASMO
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-504-4837
Mailing Address - Street 1:1150 N LOOP 1604 W
Mailing Address - Street 2:SUITE 108-466
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-4503
Mailing Address - Country:US
Mailing Address - Phone:210-504-4837
Mailing Address - Fax:210-504-4937
Practice Address - Street 1:2810 N LOOP 1604 W
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248
Practice Address - Country:US
Practice Address - Phone:210-504-4837
Practice Address - Fax:210-504-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care