Organization
HARDY OAK PVDM ENTERPRISES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER VAN DELDEN MD (CEO)
(210) 373-9647
Entity
Organization
Contact information
Practice address
23511 HARDY OAK BLVD, SAN ANTONIO, TX 78258-1928
(210) 626-8782
Mailing address
PO BOX 690804, SAN ANTONIO, TX 78269-0804
(210) 626-8782
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160490
TEXAS FACILITY LICENSE
TX
Enumeration date
11/12/2020
Last updated
06/12/2025
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