Provider Demographics
NPI:1962041558
Name:SYNERGENX HEALTH - ALAMO RANCH SAN ANTONIO LLC
Entity Type:Organization
Organization Name:SYNERGENX HEALTH - ALAMO RANCH 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:281-429-8523
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:
Mailing Address - Fax:
Practice Address - Street 1:CULEBRA COMMONS, PHASE II, W LOOP 1604 N AND CULEBRA RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254
Practice Address - Country:US
Practice Address - Phone:281-429-8523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care