| Mission Trails Family Health | |
|
4522 Fredericksburg Rd Ste A5 San Antonio TX 78201-6517 | |
| (210) 692-7171 | |
| (210) 277-7460 |
| Full Name | Mission Trails Family Health |
|---|---|
| Speciality | Family Medicine |
| Location | 4522 Fredericksburg Rd Ste A5, San Antonio, Texas |
| Authorized Official Name and Position | Linda I Esquivel (PRESIDENT) |
| Authorized Official Contact | 2106829434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mission Trails Family Health 4522 Fredericksburg Rd Ste A5 San Antonio TX 78201-6517 Ph: (210) 692-7171 | Mission Trails Family Health 4522 Fredericksburg Rd Ste A5 San Antonio TX 78201-6517 Ph: (210) 692-7171 |
| NPI Number | 1861730939 |
|---|---|
| Provider Enumeration Date | 01/24/2013 |
| Last Update Date | 03/30/2016 |
| Medicare PECOS PAC ID | 1759512114 |
|---|---|
| Medicare Enrollment ID | O20140327001713 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861730939 | NPI | - | NPPES |
| 337495103 | Medicaid | TX | |
| 337495101 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Regina K Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487787461 PECOS PAC ID: 9335208487 Enrollment ID: I20081105000182 |
| Provider Name | Jamey L Vancura |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346751179 PECOS PAC ID: 2062764350 Enrollment ID: I20181016000061 |
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