| Andala Medical Texas Pa | |
|
4600 Lockhill Selma Rd Ste 108 San Antonio TX 78249-2186 | |
| (210) 862-7246 | |
| Not Available |
| Full Name | Andala Medical Texas Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4600 Lockhill Selma Rd Ste 108, San Antonio, Texas |
| Authorized Official Name and Position | Jackie Lundin (VP PAYER RELATIONS) |
| Authorized Official Contact | 2489214652 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Andala Medical Texas Pa 4600 Lockhill Selma Rd Ste 108 San Antonio TX 78249-2186 Ph: (210) 862-7246 | Andala Medical Texas Pa 4600 Lockhill Selma Rd Ste 108 San Antonio TX 78249-2186 Ph: (210) 862-7246 |
| NPI Number | 1386224137 |
|---|---|
| Provider Enumeration Date | 04/14/2021 |
| Last Update Date | 11/10/2021 |
| Certification Date | 11/10/2021 |
| Medicare PECOS PAC ID | 7416330436 |
|---|---|
| Medicare Enrollment ID | O20220823003740 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386224137 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | John Bryan Clifton |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1336117381 PECOS PAC ID: 3577581503 Enrollment ID: I20080107000078 |
| Provider Name | John O Lusins |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689846701 PECOS PAC ID: 8123290533 Enrollment ID: I20130815000785 |
| Provider Name | Sean Ireland Huckleberry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487001392 PECOS PAC ID: 5890111843 Enrollment ID: I20200820002455 |
| Provider Name | Aaron J Cummins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225489529 PECOS PAC ID: 1052726809 Enrollment ID: I20210209001905 |
| Provider Name | Regina Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619408994 PECOS PAC ID: 3375801301 Enrollment ID: I20210423000215 |
| Provider Name | Jason Michael Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194461780 PECOS PAC ID: 3870976947 Enrollment ID: I20220823001468 |
| Provider Name | Lorraine E Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649980319 PECOS PAC ID: 9133594104 Enrollment ID: I20230404001945 |
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