Organization
PEDIATRIC EAR, NOSE & THROAT INSTITUTE OF SOUTH TEXAS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN SALAZAR (OFFICE ADMINISTRATOR)
(210) 733-4268
Entity
Organization
Contact information
Practice address
16723 HUEBNER RD, SAN ANTONIO, TX 78248-2342
(210) 733-4368
(210) 402-3417
Mailing address
PO BOX 29749, SAN ANTONIO, TX 78229-0749
(210) 733-4368
(210) 402-3417
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
095065101
MEDICAID TIP #
—
01
—
095065102
CIDC GROUP
—
05
—
095065103
—
TX
Enumeration date
06/02/2005
Last updated
05/09/2011
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