| Trinity Family Medicine Clinic Llc | |
|
6601 Blanco Rd Suite 100 San Antonio TX 78216-6102 | |
| (210) 541-0018 | |
| (210) 541-0024 |
| Full Name | Trinity Family Medicine Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 6601 Blanco Rd, San Antonio, Texas |
| Authorized Official Name and Position | Juan Pena Velazquez (PROVIDER) |
| Authorized Official Contact | 2105410018 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Family Medicine Clinic Llc 6601 Blanco Rd Suite 100 San Antonio TX 78216-6102 Ph: (210) 541-0018 | Trinity Family Medicine Clinic Llc 6601 Blanco Rd Suite 100 San Antonio TX 78216-6102 Ph: (210) 541-0018 |
| NPI Number | 1164658332 |
|---|---|
| Provider Enumeration Date | 06/02/2009 |
| Last Update Date | 08/26/2015 |
| Medicare PECOS PAC ID | 6103971437 |
|---|---|
| Medicare Enrollment ID | O20090909000742 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164658332 | NPI | - | NPPES |
| 333635601 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | N1488 (Texas) | Primary |
| Provider Name | Juan P Velazquez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396906731 PECOS PAC ID: 5496816860 Enrollment ID: I20081203000549 |
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