Provider Demographics
NPI:1821611906
Name:SYNERGENX HEALTH - NEW BRAUNFELS SAN ANTONIO LLC
Entity Type:Organization
Organization Name:SYNERGENX HEALTH - NEW BRAUNFELS SAN ANTONIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WELTON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-429-8522
Mailing Address - Street 1:16131 N ELDRIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-9130
Mailing Address - Country:US
Mailing Address - Phone:281-429-8522
Mailing Address - Fax:281-970-5913
Practice Address - Street 1:717 N BUSINESS IH 35 STE 130
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-7852
Practice Address - Country:US
Practice Address - Phone:281-429-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care