| Vicki J Sparks, Md, Pc | |
|
114 Southbridge St Suite D San Antonio TX 78216-6264 | |
| (210) 340-2707 | |
| (210) 340-2746 |
| Full Name | Vicki J Sparks, Md, Pc |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 114 Southbridge St, San Antonio, Texas |
| Authorized Official Name and Position | Vicki Jean Sparks (OWNER) |
| Authorized Official Contact | 2103402707 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vicki J Sparks, Md, Pc 114 Southbridge St Suite D San Antonio TX 78216-6264 Ph: (210) 340-2707 | Vicki J Sparks, Md, Pc 114 Southbridge St Suite D San Antonio TX 78216-6264 Ph: (210) 340-2707 |
| NPI Number | 1033545363 |
|---|---|
| Provider Enumeration Date | 09/18/2013 |
| Last Update Date | 09/18/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033545363 | NPI | - | NPPES |
| 139217710 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | E6215 (Texas) | Primary |
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