Provider Demographics
NPI: | 1922252717 |
---|---|
Name: | METHODIST PHYSICIAN PRACTICES, PLLC |
Entity Type: | Organization |
Organization Name: | METHODIST PHYSICIAN PRACTICES, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | VICE PRESIDENT |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | ROBERTA |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | CLOUD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 210-575-8501 |
Mailing Address - Street 1: | 15727 ANTHEM PKWY STE 600 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78249-4158 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-575-8501 |
Mailing Address - Fax: | 210-575-0167 |
Practice Address - Street 1: | 15727 ANTHEM PKWY STE 600 |
Practice Address - Street 2: | |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78249-4158 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-575-8501 |
Practice Address - Fax: | 210-575-0167 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-11-06 |
Last Update Date: | 2019-09-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 0002SA | Other | BCBS |
TX | 201678401 | Medicaid | |
TX | DO5906 | Other | MEDICARE RAILROAD |
TX | 201678401 | Medicaid |