Provider Demographics
NPI:1861150468
Name:GREATER SAN ANTONIO PODIATRY PLLC
Entity type:Organization
Organization Name:GREATER SAN ANTONIO PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTELLANA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-447-7058
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-4177
Mailing Address - Country:US
Mailing Address - Phone:210-447-7058
Mailing Address - Fax:210-447-7120
Practice Address - Street 1:12602 TOEPPERWEIN RD STE 205
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3271
Practice Address - Country:US
Practice Address - Phone:210-978-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty