| |
430 W. Bandera Ste 9 Boerne TX 78006-2521 | |
(210) 233-7000 | |
(210) 434-1704 |
Full Name | |
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Speciality | Clinic/Center |
Location | 430 W. Bandera, Boerne, Texas |
Authorized Official Name and Position | Hung-vy M Nguyen (CEO) |
Authorized Official Contact | 2102337070 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3066 E Commerce St San Antonio TX 78220-1013 Ph: (210) 233-7000 | 430 W. Bandera Ste 9 Boerne TX 78006-2521 Ph: (210) 233-7000 |
NPI Number | 1104207208 |
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Provider Enumeration Date | 06/15/2015 |
Last Update Date | 01/16/2023 |
Medicare PECOS PAC ID | 1153226691 |
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Medicare Enrollment ID | O20150813010598 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104207208 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
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