Provider Demographics
NPI:1780897306
Name:TY H GOLETZ M.D. PA
Entity type:Organization
Organization Name:TY H GOLETZ M.D. PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TY
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:GOLETZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-692-7400
Mailing Address - Street 1:6800 W INTERSTATE 10 STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-2038
Mailing Address - Country:US
Mailing Address - Phone:210-692-7400
Mailing Address - Fax:210-692-0090
Practice Address - Street 1:6800 W INTERSTATE 10 STE 250
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-2038
Practice Address - Country:US
Practice Address - Phone:210-692-7400
Practice Address - Fax:210-692-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750387080OtherNPI DR PONTIUS
TX1760476188OtherNPI DR GOLETZ
TX1427102821OtherNPI DR GORDON
TX1760476188OtherNPI DR GOLETZ
TX00930NMedicare PIN
TXB25588Medicare UPIN
TX0293840001Medicare NSC