Provider Demographics
NPI:1578218251
Name:RESTORE PRIMARY CARE, WELLNESS AND BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:RESTORE PRIMARY CARE, WELLNESS AND BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-383-1144
Mailing Address - Street 1:8407 DUDLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4520
Mailing Address - Country:US
Mailing Address - Phone:210-383-1144
Mailing Address - Fax:
Practice Address - Street 1:24103 RANGE WATER
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-2372
Practice Address - Country:US
Practice Address - Phone:219-385-8306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty