Provider Demographics
NPI:1528435302
Name:ASPEN MEDICAL USA INC
Entity type:Organization
Organization Name:ASPEN MEDICAL USA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-561-5777
Mailing Address - Street 1:9901 W IH 10
Mailing Address - Street 2:STE 690
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2246
Mailing Address - Country:US
Mailing Address - Phone:210-561-5777
Mailing Address - Fax:866-669-3829
Practice Address - Street 1:2662 ENCINO PARK
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-3214
Practice Address - Country:US
Practice Address - Phone:830-776-5072
Practice Address - Fax:866-669-3829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASPEN MEDICAL USA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-27
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3630576-02OtherCSHCN - CHILDREN SPECIAL HEALTHCARE NEEDS - MEDICAID
TXAM1512OtherBCBS
TX3630576-01Medicaid
TX477193Medicare PIN