Provider Demographics
NPI:1184791840
Name:MEDICAL CENTER PEDIATRICS
Entity type:Organization
Organization Name:MEDICAL CENTER PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:RUENES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-5000
Mailing Address - Street 1:2020 BABCOCK RD
Mailing Address - Street 2:19
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4440
Mailing Address - Country:US
Mailing Address - Phone:210-614-5000
Mailing Address - Fax:
Practice Address - Street 1:2020 BABCOCK RD
Practice Address - Street 2:19
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4440
Practice Address - Country:US
Practice Address - Phone:210-614-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE8874208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty