| Direct Med Clinic | |
|
1010 Nw Loop 410 Ste 100a San Antonio TX 78213-2220 | |
| (210) 886-8031 | |
| (210) 886-8059 |
| Full Name | Direct Med Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1010 Nw Loop 410 Ste 100a, San Antonio, Texas |
| Authorized Official Name and Position | Roger Moczygemba (OWNER) |
| Authorized Official Contact | 2102645500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Direct Med Clinic 1010 Nw Loop 410 Ste 100a San Antonio TX 78213-2220 Ph: (210) 886-8031 | Direct Med Clinic 1010 Nw Loop 410 Ste 100a San Antonio TX 78213-2220 Ph: (210) 886-8031 |
| NPI Number | 1689104846 |
|---|---|
| Provider Enumeration Date | 06/19/2017 |
| Last Update Date | 01/17/2019 |
| Medicare PECOS PAC ID | 9931472958 |
|---|---|
| Medicare Enrollment ID | O20170913001126 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689104846 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Marshall B Packard |
|---|---|
| Provider Type | Practitioner - Undersea And Hyperbaric Medicine |
| Provider Identifiers | NPI Number: 1538175443 PECOS PAC ID: 9436108255 Enrollment ID: I20050119000797 |
| Provider Name | Beverly S Gutierrez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023057528 PECOS PAC ID: 1153352414 Enrollment ID: I20050825001024 |
| Provider Name | Marlene A Palit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881970937 PECOS PAC ID: 3173787520 Enrollment ID: I20120614000389 |
| Provider Name | Roger Michael Moczygemba |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750382503 PECOS PAC ID: 2365427796 Enrollment ID: I20170913001391 |
| Provider Name | Mary Felix |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841675352 PECOS PAC ID: 4880902105 Enrollment ID: I20201028001254 |
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