Provider Demographics
NPI:1366631020
Name:SAN ANTONIO ADVANCED MEDICAL GROUP PA
Entity Type:Organization
Organization Name:SAN ANTONIO ADVANCED MEDICAL GROUP PA
Other - Org Name:ADVANCED MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-698-9841
Mailing Address - Street 1:24165 IH 10 W
Mailing Address - Street 2:SUITE 217, BOX 644
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1159
Mailing Address - Country:US
Mailing Address - Phone:210-698-9841
Mailing Address - Fax:210-698-9863
Practice Address - Street 1:134 MENGER SPGS
Practice Address - Street 2:SUITE 1210
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-7218
Practice Address - Country:US
Practice Address - Phone:210-698-9841
Practice Address - Fax:210-698-9863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCS5288OtherMC RAILROAD GROUP TIN
TX0088MCOtherBCBS GROUP ID
TX0A0220Medicare PIN