Provider Demographics
NPI:1013488626
Name:CAMPUS BULLIS PRIMARY CARE
Entity Type:Organization
Organization Name:CAMPUS BULLIS PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALVATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-686-0603
Mailing Address - Street 1:6865 CAMP BULLIS
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256
Mailing Address - Country:US
Mailing Address - Phone:210-686-0603
Mailing Address - Fax:
Practice Address - Street 1:6865 CAMP BULLIS
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256
Practice Address - Country:US
Practice Address - Phone:210-686-0603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care