| |
2207 S Zarzamora St San Antonio TX 78207-8024 | |
(210) 212-2266 | |
(210) 271-3600 |
Full Name | |
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Speciality | Clinic/Center |
Location | 2207 S Zarzamora St, San Antonio, Texas |
Authorized Official Name and Position | Michele Mayfield Durham (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2102122266 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1017 N Main Ave Suite 200 San Antonio TX 78212-4723 Ph: (210) 212-2266 | 2207 S Zarzamora St San Antonio TX 78207-8024 Ph: (210) 212-2266 |
NPI Number | 1144767393 |
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Provider Enumeration Date | 01/26/2017 |
Last Update Date | 05/12/2022 |
Medicare PECOS PAC ID | 2668749011 |
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Medicare Enrollment ID | O20170606002249 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144767393 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (Texas) | Primary |
Provider Name | Katrinia L Kraemer |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1649467366 PECOS PAC ID: 9032207501 Enrollment ID: I20071116000213 |
Provider Name | Fernando Garcia |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1164539508 PECOS PAC ID: 6507919263 Enrollment ID: I20090729000252 |
Provider Name | Maresah Harris |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1558072611 PECOS PAC ID: 5991237513 Enrollment ID: I20241021000573 |
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