Provider Demographics
NPI:1346848223
Name:DR. MARY DIANE WAY
Entity Type:Organization
Organization Name:DR. MARY DIANE WAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACCALLUM-SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:BILLING
Authorized Official - Phone:210-623-0140
Mailing Address - Street 1:1811 BURR OAK LN
Mailing Address - Street 2:
Mailing Address - City:ADKINS
Mailing Address - State:TX
Mailing Address - Zip Code:78101-2606
Mailing Address - Country:US
Mailing Address - Phone:210-364-2430
Mailing Address - Fax:
Practice Address - Street 1:1811 BURR OAK LN
Practice Address - Street 2:
Practice Address - City:ADKINS
Practice Address - State:TX
Practice Address - Zip Code:78101-2606
Practice Address - Country:US
Practice Address - Phone:210-364-2430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1508857608OtherBILLING FOR DR. WAY