Provider Demographics
NPI:1285856591
Name:SAN ANTONIO MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:SAN ANTONIO MEDICAL CLINIC PA
Other - Org Name:ALAMO BONE & JOINT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-3900
Mailing Address - Street 1:12770 CIMARRON PATH
Mailing Address - Street 2:SUITE 132
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3427
Mailing Address - Country:US
Mailing Address - Phone:210-614-3900
Mailing Address - Fax:210-614-7270
Practice Address - Street 1:12770 CIMARRON PATH
Practice Address - Street 2:SUITE 132
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3427
Practice Address - Country:US
Practice Address - Phone:210-614-3900
Practice Address - Fax:210-614-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4560174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137028008Medicaid
204068400OtherU S DEPT OF LABOR
TX10279OtherUS DEPT OF LABOR & IND
TX00L647Medicare ID - Type Unspecified
TX10279OtherUS DEPT OF LABOR & IND
TX89A512Medicare UPIN
TX0785260001Medicare NSC