Provider Demographics
NPI:1942416631
Name:AMC PRESIDIO CLINIC
Entity Type:Organization
Organization Name:AMC PRESIDIO CLINIC
Other - Org Name:DAVID W SANCHEZ
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-837-5505
Mailing Address - Street 1:501 E O'RIELLY ST
Mailing Address - Street 2:
Mailing Address - City:PRESIDIO
Mailing Address - State:TX
Mailing Address - Zip Code:79845
Mailing Address - Country:US
Mailing Address - Phone:432-229-4246
Mailing Address - Fax:432-229-4249
Practice Address - Street 1:501 E O'RIELLY ST
Practice Address - Street 2:
Practice Address - City:PRESIDIO
Practice Address - State:TX
Practice Address - Zip Code:79845
Practice Address - Country:US
Practice Address - Phone:432-229-4246
Practice Address - Fax:432-229-4249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPINE MEDICAL CENTER/AMC CLINIC PRESIDIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86W850OtherBCBS
TX111586704Medicaid
TX111586703Medicaid
TX121446OtherSUPERIORHEALTH
TX125762OtherSUPERIORHEALTHALPINE
TX111586701Medicaid
TX111586702Medicaid
TX129492801Medicaid
TX86W850OtherBCBS
TXF55899Medicare UPIN