| Centromed Santa Rosaclinic/ryran White Clinic | |
|
315 N San Saba Suite # 103 San Antonio TX 78207-3154 | |
| (210) 922-7000 | |
| (210) 924-1374 |
| Full Name | Centromed Santa Rosaclinic/ryran White Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 315 N San Saba, San Antonio, Texas |
| Authorized Official Name and Position | Chuck 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 Santa Rosaclinic/ryran White Clinic 3750 Commercial Ave San Antonio TX 78221-3117 Ph: (210) 334-3700 | Centromed Santa Rosaclinic/ryran White Clinic 315 N San Saba Suite # 103 San Antonio TX 78207-3154 Ph: (210) 922-7000 |
| NPI Number | 1699841569 |
|---|---|
| Provider Enumeration Date | 11/24/2006 |
| Last Update Date | 10/25/2019 |
| Medicare PECOS PAC ID | 6800881285 |
|---|---|
| Medicare Enrollment ID | O20050303000547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699841569 | NPI | - | NPPES |
| 120980101 | Medicaid | TX | |
| 120980102 | Medicaid | TX | |
| 120980105 | Medicaid | TX | |
| 00MT08 | Other | TX | GROUP MEDICARE |
| 120980103 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | HBOCS00758-04-00 (Texas) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | HBOCS00758-04-00 (Texas) | Primary |
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