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4402 Vance Jackson Rd Ste 146 San Antonio TX 78230-5333 | |
| (210) 962-5557 | |
| (210) 962-5558 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4402 Vance Jackson Rd Ste 146, San Antonio, Texas |
| Authorized Official Name and Position | Andrew W Wong (OWNER/PROVIDER) |
| Authorized Official Contact | 2109625557 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
4402 Vance Jackson Rd Ste 146 San Antonio TX 78230-5333 Ph: (210) 962-5557 | 4402 Vance Jackson Rd Ste 146 San Antonio TX 78230-5333 Ph: (210) 962-5557 |
| NPI Number | 1710408265 |
|---|---|
| Provider Enumeration Date | 07/05/2017 |
| Last Update Date | 03/31/2022 |
| Certification Date | 03/31/2022 |
| Medicare PECOS PAC ID | 9638444573 |
|---|---|
| Medicare Enrollment ID | O20171003007148 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710408265 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Andrew W Wong |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1407172521 PECOS PAC ID: 0042525362 Enrollment ID: I20171003007478 |
| Provider Name | Jessica Webster |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366021750 PECOS PAC ID: 8224435896 Enrollment ID: I20210923003144 |
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