Organization
BIGFOOT PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN VINE PNP (OWNER)
(210) 570-3323
Entity
Organization
Contact information
Practice address
2515 CASTROVILLE RD STE 4, SAN ANTONIO, TX 78237-3361
(860) 501-9739
Mailing address
101 FAZIO DR, CIBOLO, TX 78108-3292
(210) 570-3323
(857) 219-4219
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
01/29/2025
Last updated
01/29/2025
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