Provider Demographics
NPI:1366691867
Name:KERR COUNTY SUB-SPECIALISTS, PA
Entity Type:Organization
Organization Name:KERR COUNTY SUB-SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-896-2900
Mailing Address - Street 1:PO BOX 293279
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-3279
Mailing Address - Country:US
Mailing Address - Phone:830-896-2900
Mailing Address - Fax:830-896-8905
Practice Address - Street 1:306 WESLEY DR STE B
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5822
Practice Address - Country:US
Practice Address - Phone:830-896-2900
Practice Address - Fax:830-896-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ87142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty