Provider Demographics
NPI:1528003076
Name:PEDIATRIC ORTHOPEDIC ASSOCIATES OF SAN ANTONIO
Entity type:Organization
Organization Name:PEDIATRIC ORTHOPEDIC ASSOCIATES OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-692-1613
Mailing Address - Street 1:4499 MEDICAL DR.
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3712
Mailing Address - Country:US
Mailing Address - Phone:210-692-1613
Mailing Address - Fax:210-616-0290
Practice Address - Street 1:4499 MEDICAL DR.
Practice Address - Street 2:SUITE 235
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3712
Practice Address - Country:US
Practice Address - Phone:210-692-1613
Practice Address - Fax:210-616-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121751505Medicaid
TX121751506OtherCSHCN
TX121751501Medicaid