Provider Demographics
NPI:1669668083
Name:SHAVANO FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:SHAVANO FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:FINNIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-561-2422
Mailing Address - Street 1:12000 HUEBNER RD
Mailing Address - Street 2:#104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1213
Mailing Address - Country:US
Mailing Address - Phone:210-561-2422
Mailing Address - Fax:210-561-2466
Practice Address - Street 1:12000 HUEBNER RD
Practice Address - Street 2:#104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1213
Practice Address - Country:US
Practice Address - Phone:210-561-2422
Practice Address - Fax:210-561-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF33099Medicare UPIN