Provider Demographics
NPI:1568848059
Name:CUMBERLAND SURGICAL HOSPITAL OF SAN ANTONIO LLC
Entity type:Organization
Organization Name:CUMBERLAND SURGICAL HOSPITAL OF SAN ANTONIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-216-6285
Mailing Address - Street 1:5330 N LOOP 1604 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4383
Mailing Address - Country:US
Mailing Address - Phone:682-223-5552
Mailing Address - Fax:682-223-5560
Practice Address - Street 1:5330 N LOOP 1604 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-877-8000
Practice Address - Fax:210-694-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-06
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361949602Medicaid
TX361949601Medicaid
TX361949601Medicaid