Provider Demographics
NPI:1649391632
Name:SAMUEL R NEELEY MD PA
Entity Type:Organization
Organization Name:SAMUEL R NEELEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:NEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-525-1668
Mailing Address - Street 1:PO BOX 700447
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0447
Mailing Address - Country:US
Mailing Address - Phone:210-525-1668
Mailing Address - Fax:210-525-1669
Practice Address - Street 1:12446 WEST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2517
Practice Address - Country:US
Practice Address - Phone:210-525-1668
Practice Address - Fax:210-525-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8757208M00000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0015PZOtherBLUE CROSS
TX004203225OtherAETNA HEALTHCARE
TX120344004Medicaid
TX=========OtherCHAMPUS
TX120344004Medicaid
TX0015PZOtherBLUE CROSS