| Centromed Indian Creek Clinic | |
|
5439 Ray Ellison Blvd San Antonio TX 78242-2219 | |
| (210) 922-7000 | |
| (210) 457-3392 |
| Full Name | Centromed Indian Creek Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 5439 Ray Ellison Blvd, San Antonio, Texas |
| Authorized Official Name and Position | Lawrence C Walzel (VP/CFO) |
| Authorized Official Contact | 2103343724 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centromed Indian Creek Clinic 3750 Commercial Ave San Antonio TX 78221-3117 Ph: (210) 922-7000 | Centromed Indian Creek Clinic 5439 Ray Ellison Blvd San Antonio TX 78242-2219 Ph: (210) 922-7000 |
| NPI Number | 1801389044 |
|---|---|
| Provider Enumeration Date | 06/12/2018 |
| Last Update Date | 01/30/2019 |
| Medicare PECOS PAC ID | 6800881285 |
|---|---|
| Medicare Enrollment ID | O20181106000885 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801389044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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