Provider Demographics
NPI:1366626517
Name:KERRVILLE MEDICAL SERVICES, PA
Entity Type:Organization
Organization Name:KERRVILLE MEDICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, KERRVILLE MEDICAL SERVIC
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-238-6123
Mailing Address - Street 1:1365 SADDLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-7231
Mailing Address - Country:US
Mailing Address - Phone:830-238-6123
Mailing Address - Fax:
Practice Address - Street 1:145 LA HACIENDA WAY
Practice Address - Street 2:LA HACIENDA TREATMENT CENTER
Practice Address - City:HUNT
Practice Address - State:TX
Practice Address - Zip Code:78024
Practice Address - Country:US
Practice Address - Phone:830-238-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6460207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty