Organization
KIDNEY TREATMENT CENTER SAN ANTONIO INC
Active
Organization
KIDNEY TREATMENT CENTER SAN ANTONIO INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA J MEDOLA (SUPERVISOR)
(210) 692-1515
Entity
Organization
Contact information
Practice address
803 CASTROVILLE RD, STE 401, SAN ANTONIO, TX 78237-3148
(210) 435-4725
(210) 433-8826
Mailing address
3939 MEDICAL DR STE 110, STE 110, SAN ANTONIO, TX 78229-2292
(210) 692-1515
(210) 692-0187
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
000043
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0210833-01
—
TX
05
—
0878423-01
—
TX
01
—
HH6150
BC/BS
TX
Enumeration date
06/08/2005
Last updated
04/07/2010
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