Provider Demographics
NPI:1558638262
Name:SPIRE MEDICAL MANAGEMENT, INC
Entity Type:Organization
Organization Name:SPIRE MEDICAL MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUESBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-438-8055
Mailing Address - Street 1:323 NW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3209
Mailing Address - Country:US
Mailing Address - Phone:210-438-8055
Mailing Address - Fax:210-979-7843
Practice Address - Street 1:323 NW 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3209
Practice Address - Country:US
Practice Address - Phone:210-438-8055
Practice Address - Fax:210-979-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty