Provider Demographics
NPI:1033558028
Name:SPORTS AND FAMILY MEDICINE OF BOERNE PA
Entity Type:Organization
Organization Name:SPORTS AND FAMILY MEDICINE OF BOERNE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WOODROW
Authorized Official - Last Name:MCCURLEY
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:830-328-3559
Mailing Address - Street 1:136 OLD SAN ANTONIO RD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3413
Mailing Address - Country:US
Mailing Address - Phone:830-328-3559
Mailing Address - Fax:
Practice Address - Street 1:136 OLD SAN ANTONIO RD
Practice Address - Street 2:SUITE 406
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3413
Practice Address - Country:US
Practice Address - Phone:830-328-3559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-23
Last Update Date:2013-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7720207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty