| Execudoc, Inc | |
|
7720 Jones Maltsberger Rd Suite 110 San Antonio TX 78216-6946 | |
| (210) 822-2004 | |
| (210) 822-2215 |
| Full Name | Execudoc, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 7720 Jones Maltsberger Rd, San Antonio, Texas |
| Authorized Official Name and Position | Mark L Thornton (OWNER) |
| Authorized Official Contact | 2108222004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Execudoc, Inc 7720 Jones Maltsberger Rd Suite 110 San Antonio TX 78216-6946 Ph: (210) 822-2004 | Execudoc, Inc 7720 Jones Maltsberger Rd Suite 110 San Antonio TX 78216-6946 Ph: (210) 822-2004 |
| NPI Number | 1730386905 |
|---|---|
| Provider Enumeration Date | 06/29/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 6305822438 |
|---|---|
| Medicare Enrollment ID | O20040628001559 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730386905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Jennifer L Wallace |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699760934 PECOS PAC ID: 5597958033 Enrollment ID: I20101018000203 |
| Provider Name | Mark Lee Thornton |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1669552790 PECOS PAC ID: 3476539503 Enrollment ID: I20160224002265 |
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