Provider Demographics
NPI:1902398365
Name:SOUTH TEXAS SKIN CANCER CENTER LLC
Entity Type:Organization
Organization Name:SOUTH TEXAS SKIN CANCER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-890-1508
Mailing Address - Street 1:2632 BROADWAY ST STE 300S
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1137
Mailing Address - Country:US
Mailing Address - Phone:210-558-6234
Mailing Address - Fax:210-446-5039
Practice Address - Street 1:2632 BROADWAY ST
Practice Address - Street 2:STE 300 SOUTH
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1137
Practice Address - Country:US
Practice Address - Phone:210-558-6234
Practice Address - Fax:210-446-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1902398365Medicaid