Provider Demographics
NPI:1821402660
Name:STONETERRA INFUSION CENTER
Entity type:Organization
Organization Name:STONETERRA INFUSION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-588-1050
Mailing Address - Street 1:150 E SONTERRA BLVD STE 170B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4098
Mailing Address - Country:US
Mailing Address - Phone:281-481-2800
Mailing Address - Fax:281-481-2834
Practice Address - Street 1:150 E SONTERRA BLVD STE 170B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4098
Practice Address - Country:US
Practice Address - Phone:281-481-2800
Practice Address - Fax:281-481-2834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy