Provider Demographics
NPI:1518787845
Name:SOUTH TEXAS SPECIALTY CARE PLLC
Entity type:Organization
Organization Name:SOUTH TEXAS SPECIALTY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CYRIL
Authorized Official - Middle Name:COMPTON
Authorized Official - Last Name:GAIENNIE
Authorized Official - Suffix:III
Authorized Official - Credentials:DNP
Authorized Official - Phone:210-550-2877
Mailing Address - Street 1:19236 REATA TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4025
Mailing Address - Country:US
Mailing Address - Phone:210-550-5531
Mailing Address - Fax:210-866-4587
Practice Address - Street 1:225 E SONTERRA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3995
Practice Address - Country:US
Practice Address - Phone:210-550-2877
Practice Address - Fax:210-866-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care