| Kellum Medical Group, Pa | |
|
7323 Marbach Rd Ste 104 San Antonio TX 78227-1905 | |
| (210) 674-0257 | |
| (210) 369-9064 |
| Full Name | Kellum Medical Group, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 7323 Marbach Rd Ste 104, San Antonio, Texas |
| Authorized Official Name and Position | Kristi Braker (CREDENTIALING AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 2106740257 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kellum Medical Group, Pa 7323 Marbach Rd Ste 104 San Antonio TX 78227-1905 Ph: (210) 674-0257 | Kellum Medical Group, Pa 7323 Marbach Rd Ste 104 San Antonio TX 78227-1905 Ph: (210) 674-0257 |
| NPI Number | 1508813494 |
|---|---|
| Provider Enumeration Date | 05/27/2006 |
| Last Update Date | 01/16/2025 |
| Medicare PECOS PAC ID | 7416981659 |
|---|---|
| Medicare Enrollment ID | O20050927000140 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508813494 | NPI | - | NPPES |
| 45D1026258 | Other | TX | CLIA - KELLUM MEDICAL GROUP, PA - PEDIATRICS |
| 1174518625 | Other | TX | DANIEL H KELLUM SR., DO - NPI |
| CH6982 | Other | TX | MEDICARE RR GROUP PTAN# |
| 1265413264 | Other | TX | ALICE T. BLACKMON, NP-C / NPI# |
| 1588641377 | Other | TX | SALVADOR VAZQUEZ, MD / NPI# |
| 193200000X | Other | TX | GROUP TAXONOMY |
| 1346646510 | Other | TX | MATTHEW ARISMENDEZ, PA-C / NPI# |
| R-14400 | Other | TX | RADIOLOGY & X-RAY CERT# |
| 00295N | Other | TX | MEDICARE GROUP PTAN# |
| 1063070308 | Other | TX | MANUELA BERRY, NP-C / NPI# |
| 45D0671939 | Other | TX | CLIA - KELLUM MEDICAL GROUP, PA |
| 1366623639 | Other | TX | KIMBERLY 'KIM' DIAZ, PA-C |
| 1508813494 | Medicaid | TX |
| Provider Name | Maria Elena L Cantu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225236888 PECOS PAC ID: 8527953470 Enrollment ID: I20040218001113 |
| Provider Name | Alicia T Blackmon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265413264 PECOS PAC ID: 2163448382 Enrollment ID: I20051018000261 |
| Provider Name | Salvador C Vazquez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588641377 PECOS PAC ID: 3678636933 Enrollment ID: I20090113000245 |
| Provider Name | Daniel H Kellum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174518625 PECOS PAC ID: 7517991755 Enrollment ID: I20100305000437 |
| Provider Name | Berthony Bien-aime |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194276683 PECOS PAC ID: 0143505438 Enrollment ID: I20170329001142 |
| Provider Name | Manuela Berry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063070308 PECOS PAC ID: 7719313949 Enrollment ID: I20200207000744 |
Doctor At Your Service Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4242 Medical Dr, Suite 6250, San Antonio, TX 78229 Phone: 210-479-3297 Fax: 210-479-3295 | |
Alexis Wiesenthal Md Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8038 Wurzbach Rd Ste 320, San Antonio, TX 78229 Phone: 210-614-3365 | |
R Family Medical Group, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3110 Nogalitos, Suite 105, San Antonio, TX 78225 Phone: 210-533-0257 Fax: 210-531-9488 | |
Insulin Rounds P A Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12951 Huebner Rd, #780355, San Antonio, TX 78278 Phone: 210-862-5506 | |