Provider Demographics
| NPI: | 1376501668 |
|---|---|
| Name: | TEXAS INSTITUTE OF MEDICINE AND SURGERY |
| Entity type: | Organization |
| Organization Name: | TEXAS INSTITUTE OF MEDICINE AND SURGERY |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | COO |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | ROBERTA |
| Authorized Official - Middle Name: | S |
| Authorized Official - Last Name: | CLOUD |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 210-575-8500 |
| Mailing Address - Street 1: | 7711 LOUIS PASTEUR DR |
| Mailing Address - Street 2: | SUITE 707 |
| Mailing Address - City: | SAN ANTONIO |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 78229-3415 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 210-575-6755 |
| Mailing Address - Fax: | 210-575-6902 |
| Practice Address - Street 1: | 7711 LOUIS PASTEUR DR |
| Practice Address - Street 2: | SUITE 707 |
| Practice Address - City: | SAN ANTONIO |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78229-3415 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 210-575-6755 |
| Practice Address - Fax: | 210-575-6902 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-03 |
| Last Update Date: | 2008-11-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 207RI0008X | Allopathic & Osteopathic Physicians | Internal Medicine | Hepatology | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
| No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
| No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | Group - Multi-Specialty |
| No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Multi-Specialty | |
| No | 364SP0200X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Pediatrics | Group - Multi-Specialty |
| No | 364SN0800X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Neuroscience | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 083784102 | Medicaid | |
| TX | CG5475 | Other | MEDICARE RAILROAD |
| TX | CG5475 | Other | MEDICARE RAILROAD |
