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Kelly Ann Gardner

Anesthesiology

Allopathic & Osteopathic Physicians

4502 Medical Dr, San Antonio, TX 78229-4402

PECOS Enrollment

This provider is enrolled in PECOS as KELLY GARDNER.

Based on the most recent information from CMS, provider Kelly Ann Gardner is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1164716593
Provider Type
Individual
Full Name
Gardner, Kelly Ann
Title
Dr.
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
6/2/2011
Last Updated
8/7/2015

Contact Information

Practice Location

4502 Medical Dr, San Antonio, TX 78229-4402

(210) 358-4000

Unlisted Fax

Mailing Location

7703 Floyd Curl Dr, San Antonio, TX 78229-3901

(210) 567-4500

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207L00000X Primary	Description Anesthesiology Allopathic & Osteopathic Physicians	License Q2550 Texas

Provider Identifiers

ID	Description	Issuer
ID 346004001	Description Medicaid	Issuer Unlisted Texas

Kelly Ann Gardner

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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Bustamante, Julia Anne

Fitzpatrick, Molly

Michael Wissa, Md, Pllc

Nguyen, Patrick

Shaddock, William

Trevino, Kimberly Danielle

Franklin L. Anderson, Md, Pllc

Stypula, Daniel

Vicari, Brian Peter