Provider Demographics
NPI:1346369253
Name:SAN ANTONIO INTERNAL MEDICINE GROUP PA
Entity Type:Organization
Organization Name:SAN ANTONIO INTERNAL MEDICINE GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-223-9617
Mailing Address - Street 1:1303 MCCULLOUGH AVE
Mailing Address - Street 2:SUITE 560
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5609
Mailing Address - Country:US
Mailing Address - Phone:210-223-9617
Mailing Address - Fax:210-568-1910
Practice Address - Street 1:1303 MCCULLOUGH AVE
Practice Address - Street 2:SUITE 560
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5609
Practice Address - Country:US
Practice Address - Phone:210-223-9617
Practice Address - Fax:210-568-1910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX882167Medicare PIN
TX882166Medicare PIN
00LK38Medicare PIN
TX87500KMedicare PIN
TX882170Medicare PIN