NPIMap

Organization Active NPI

University of the Incarnate Word

Doing business as University of the Incarnate Word Sports Medicine

  • Orthopaedic Surgery Physician
  • San Antonio, TX
National Provider Identifier
1780057513
Registry record updated Oct 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
UNIVERSITY OF THE INCARNATE WORD
Doing business as
University of the Incarnate Word Sports Medicine
Practice address
4301 Broadway St # 288
San Antonio, TX 78209-6318
Phone
(210) 283-6481
Fax
(210) 634-1252
NPI assigned
Nov 2, 2015
Last updated
Oct 2, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
BJ Lough
Title
Associate Athletic Dir Sport Med
Phone
(210) 283-6481

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Orthopaedic Surgery Physician 207X00000X NU Primary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X NU

Addresses

Primary practice location

4301 Broadway St # 288
San Antonio, TX 78209-6318

Mailing address

4301 Broadway St # 288
San Antonio, TX 78209-6318
Phone (210) 283-6481

Other names 1

  • University of the Incarnate Word Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Eye Vision Care Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4301 Broadway
#288
San Antonio, TX 78209
Phone (210) 283-6481

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1446422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538438400000",
    "number": "1780057513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 BROADWAY ST # 288",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782096318",
            "telephone_number": "210-283-6481",
            "fax_number": "210-634-1252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 BROADWAY ST # 288",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782096318",
            "telephone_number": "210-283-6481",
            "fax_number": "210-634-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF THE INCARNATE WORD",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-02",
        "last_updated": "2018-10-02",
        "status": "A",
        "authorized_official_last_name": "LOUGH",
        "authorized_official_first_name": "BJ",
        "authorized_official_title_or_position": "ASSOCIATE ATHLETIC DIR SPORT MED",
        "authorized_official_telephone_number": "210-283-6481"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University of the Incarnate Word Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of the Incarnate Word Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.