Provider Demographics
NPI:1205873288
Name:SEGUIN SURGICAL CLINIC, P.A.
Entity type:Organization
Organization Name:SEGUIN SURGICAL CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERAPIO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-372-4891
Mailing Address - Street 1:515 N KING ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-4815
Mailing Address - Country:US
Mailing Address - Phone:830-372-4891
Mailing Address - Fax:830-379-3096
Practice Address - Street 1:515 N KING ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-4801
Practice Address - Country:US
Practice Address - Phone:830-372-4891
Practice Address - Fax:830-379-3096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3534208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R13RMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TXC22955Medicare UPIN