Provider Demographics
NPI:1679836357
Name:SAN ANTONIO CLINICAL GENETICS PA
Entity Type:Organization
Organization Name:SAN ANTONIO CLINICAL GENETICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-255-2027
Mailing Address - Street 1:2632 BROADWAY ST
Mailing Address - Street 2:SUITE 104 SOUTH
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1137
Mailing Address - Country:US
Mailing Address - Phone:210-255-2027
Mailing Address - Fax:210-226-0050
Practice Address - Street 1:2632 BROADWAY ST
Practice Address - Street 2:SUITE 104 SOUTH
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1137
Practice Address - Country:US
Practice Address - Phone:210-255-2027
Practice Address - Fax:210-226-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Single Specialty