Provider Demographics
NPI:1336321090
Name:IMPULSE INC
Entity Type:Organization
Organization Name:IMPULSE INC
Other - Org Name:FAMILY HEALTH AND WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-737-9615
Mailing Address - Street 1:PO BOX 40013
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-1013
Mailing Address - Country:US
Mailing Address - Phone:210-615-0110
Mailing Address - Fax:210-615-9977
Practice Address - Street 1:9720 DATAPOINT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2046
Practice Address - Country:US
Practice Address - Phone:210-615-0110
Practice Address - Fax:210-615-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0087DEOtherBCBS
TX81503XOtherBCBS
TX81503XOtherBCBS