Provider Demographics
NPI:1396954616
Name:MEDICAL RESEARCH ASSOC, INC
Entity type:Organization
Organization Name:MEDICAL RESEARCH ASSOC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:W
Authorized Official - Last Name:KITTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-475-9020
Mailing Address - Street 1:920 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4607
Mailing Address - Country:US
Mailing Address - Phone:210-475-9020
Mailing Address - Fax:210-222-8354
Practice Address - Street 1:920 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4607
Practice Address - Country:US
Practice Address - Phone:210-475-9020
Practice Address - Fax:210-222-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4457174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24003Medicare UPIN
TXC18531Medicare UPIN