Provider Demographics
NPI:1568280808
Name:SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO, PA
Entity type:Organization
Organization Name:SPORTS MEDICINE ASSOCIATES OF SAN ANTONIO, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRKELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-756-5240
Mailing Address - Street 1:PO BOX 268996
Mailing Address - Street 2:DEPT 1131
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126
Mailing Address - Country:US
Mailing Address - Phone:210-699-8326
Mailing Address - Fax:
Practice Address - Street 1:10622 STATE HIGHWAY 151 STE 205
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4729
Practice Address - Country:US
Practice Address - Phone:210-699-8326
Practice Address - Fax:210-561-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies