Provider Demographics
NPI:1134512122
Name:SCOCCIA MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SCOCCIA MEDICAL SERVICES, PLLC
Other - Org Name:KERRVILLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-896-0404
Mailing Address - Street 1:PO BOX 294898
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-4898
Mailing Address - Country:US
Mailing Address - Phone:830-896-0404
Mailing Address - Fax:830-896-4343
Practice Address - Street 1:707 HILL COUNTRY DR
Practice Address - Street 2:STE 106
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5996
Practice Address - Country:US
Practice Address - Phone:830-896-0404
Practice Address - Fax:830-896-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-14
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX564441Medicare PIN