Provider Demographics
NPI:1114127347
Name:ISAAC SOSA M.D. P.A.
Entity Type:Organization
Organization Name:ISAAC SOSA M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:CHAMPAGNE-MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:512-225-6345
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78802-1288
Mailing Address - Country:US
Mailing Address - Phone:830-278-6265
Mailing Address - Fax:830-278-6286
Practice Address - Street 1:1195 GARNER FIELD RD
Practice Address - Street 2:STE. 400
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-4822
Practice Address - Country:US
Practice Address - Phone:830-278-6265
Practice Address - Fax:830-278-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7829261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079736701Medicaid
TX138814206Medicaid
TXCH4353OtherMEDICARE RAILROAD
TX00060NOtherBCBS
TX110225317OtherMEDICARE RAILROAD
TX86590NOtherBCBS
TX00060NMedicare Oscar/Certification
TXCH4353OtherMEDICARE RAILROAD
TX138814206Medicaid