Provider Demographics
NPI:1578631040
Name:TEXAS HEALTHNET MEDICAL CLINIC LTD.
Entity Type:Organization
Organization Name:TEXAS HEALTHNET MEDICAL CLINIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-877-0772
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78293-0806
Mailing Address - Country:US
Mailing Address - Phone:210-877-0772
Mailing Address - Fax:210-877-0785
Practice Address - Street 1:12730 W IH 10
Practice Address - Street 2:SUITE 306
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1003
Practice Address - Country:US
Practice Address - Phone:210-877-0772
Practice Address - Fax:210-877-0785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140228133Medicaid
TX00926ZMedicare PIN
TXC23125Medicare UPIN
TX140228133Medicaid