Provider Demographics
NPI:1144767393
Name:BEAT AIDS COALITION TRUST
Entity Type:Organization
Organization Name:BEAT AIDS COALITION TRUST
Other - Org Name:YOUR CHOICE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:MAYFIELD
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:210-212-2266
Mailing Address - Street 1:1017 N MAIN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4723
Mailing Address - Country:US
Mailing Address - Phone:210-212-2266
Mailing Address - Fax:210-271-3600
Practice Address - Street 1:2207 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-8024
Practice Address - Country:US
Practice Address - Phone:210-212-2266
Practice Address - Fax:210-271-3600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEAT AIDS COALITION TRUST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-26
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center