| Tlg | |
|
17300 Henderson Pass Suite 260 San Antonio TX 78232-1663 | |
| (210) 908-7573 | |
| (210) 807-8789 |
| Full Name | Tlg |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 17300 Henderson Pass, San Antonio, Texas |
| Authorized Official Name and Position | Richard Palmer Lahaye (PRACTICE MANAGER) |
| Authorized Official Contact | 2109087573 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tlg 17300 Henderson Pass Ste 260 San Antonio TX 78232-1568 Ph: (210) 908-7573 | Tlg 17300 Henderson Pass Suite 260 San Antonio TX 78232-1663 Ph: (210) 908-7573 |
| NPI Number | 1326579251 |
|---|---|
| Provider Enumeration Date | 03/22/2017 |
| Last Update Date | 02/05/2019 |
| Medicare PECOS PAC ID | 2264772854 |
|---|---|
| Medicare Enrollment ID | O20190318002295 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326579251 | NPI | - | NPPES |
| Provider Name | Jimmy W Mcmanus |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861512006 PECOS PAC ID: 2062487226 Enrollment ID: I20040831000903 |
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