| Atlantic Family Healthcare | |
|
11403 Oconnor Rd Ste. 108 San Antonio TX 78233-5390 | |
| (210) 657-3700 | |
| (210) 657-3708 |
| Full Name | Atlantic Family Healthcare |
|---|---|
| Speciality | Clinic/Center |
| Location | 11403 Oconnor Rd, San Antonio, Texas |
| Authorized Official Name and Position | Ughanmwan Efeovbokhan (OWNER) |
| Authorized Official Contact | 2106573700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Atlantic Family Healthcare 11403 Oconnor Rd Ste. 108 San Antonio TX 78233-5390 Ph: (210) 657-3700 | Atlantic Family Healthcare 11403 Oconnor Rd Ste. 108 San Antonio TX 78233-5390 Ph: (210) 657-3700 |
| NPI Number | 1992973200 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 02/28/2019 |
| Medicare PECOS PAC ID | 2961566658 |
|---|---|
| Medicare Enrollment ID | O20090123000573 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992973200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | PA01295 (Texas) | Primary |
| Provider Name | Ughanmwan T Efeovbokhan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649387630 PECOS PAC ID: 7113992611 Enrollment ID: I20040828000071 |
| Provider Name | Justo L Cisneros |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427168061 PECOS PAC ID: 3173541760 Enrollment ID: I20051102000529 |
| Provider Name | Angella Michelle Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154729358 PECOS PAC ID: 4486746963 Enrollment ID: I20160517002405 |
| Provider Name | Gwendolyn L Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053894857 PECOS PAC ID: 1254670078 Enrollment ID: I20190221003050 |
| Provider Name | Juliet Makena Gatobu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245711050 PECOS PAC ID: 2769728765 Enrollment ID: I20220126000320 |
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