Provider Demographics
NPI:1982193462
Name:ALIVIO HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:ALIVIO HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:210-364-2007
Mailing Address - Street 1:6136 BANDERA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1642
Mailing Address - Country:US
Mailing Address - Phone:210-593-4000
Mailing Address - Fax:210-593-4003
Practice Address - Street 1:6136 BANDERA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1642
Practice Address - Country:US
Practice Address - Phone:210-593-4000
Practice Address - Fax:210-593-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00510363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty