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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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