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918 Wagner San Antonio TX 78211-3218 | |
| (210) 932-3500 | |
| (210) 924-6778 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 918 Wagner, San Antonio, Texas |
| Authorized Official Name and Position | Chuck Walzel (CFO) |
| Authorized Official Contact | 2103343724 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3750 Commercial Ave San Antonio TX 78221-3117 Ph: (210) 334-3700 | 918 Wagner San Antonio TX 78211-3218 Ph: (210) 932-3500 |
| NPI Number | 1467592683 |
|---|---|
| Provider Enumeration Date | 02/07/2007 |
| Last Update Date | 11/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467592683 | NPI | - | NPPES |
| 120980102 | Medicaid | TX | |
| 120980103 | Medicaid | TX | |
| 4587537 | Other | TX | NABP |
| 00MT08 | Other | TX | GROUP MEDICARE |
| 120980101 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | HBOCS007580400 (Texas) | Primary |
| 3336C0002X | Pharmacy - Clinic Pharmacy | HBOCS007580400 (Texas) | Secondary |
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