Provider Demographics
NPI:1104011329
Name:SOUTH TEXAS PM & R GROUP, INC.
Entity Type:Organization
Organization Name:SOUTH TEXAS PM & R GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-615-2225
Mailing Address - Street 1:PO BOX 380635
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78268-7635
Mailing Address - Country:US
Mailing Address - Phone:210-615-2225
Mailing Address - Fax:210-615-8432
Practice Address - Street 1:2 SPURS LN STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1760
Practice Address - Country:US
Practice Address - Phone:210-615-2255
Practice Address - Fax:210-615-8432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112882902Medicaid
TXOOU54EOtherBLUE CROSS/BLUE SHIELD
TXOOU54EOtherBLUE CROSS/BLUE SHIELD