Provider Demographics
NPI:1336416445
Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER SAN ANTONIO
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT EVALUATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:DIANN
Authorized Official - Last Name:PASCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:214-577-7815
Mailing Address - Street 1:36000 DARNALL LOOP # 47
Mailing Address - Street 2:ROOM 1417
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5095
Mailing Address - Country:US
Mailing Address - Phone:254-288-1638
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP # 47
Practice Address - Street 2:ROOM 1417
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-288-1638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit