Provider Demographics
NPI:1639360506
Name:SAMMY VICK MD PA
Entity Type:Organization
Organization Name:SAMMY VICK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-616-0410
Mailing Address - Street 1:8038 WURZBACH RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3817
Mailing Address - Country:US
Mailing Address - Phone:210-616-0410
Mailing Address - Fax:210-615-1295
Practice Address - Street 1:8038 WURZBACH RD
Practice Address - Street 2:SUITE 430
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3817
Practice Address - Country:US
Practice Address - Phone:210-616-0410
Practice Address - Fax:210-615-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8485208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty