Provider Demographics
NPI:1669701959
Name:GREATER SA HOUSE CALLS, LLC
Entity type:Organization
Organization Name:GREATER SA HOUSE CALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:UGHANMWAN
Authorized Official - Middle Name:TOKUNBOR
Authorized Official - Last Name:EFEOVBOKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:GNP
Authorized Official - Phone:210-789-1274
Mailing Address - Street 1:9531 AUTUMN BREEZE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-1969
Mailing Address - Country:US
Mailing Address - Phone:210-647-4671
Mailing Address - Fax:210-647-7552
Practice Address - Street 1:5309 WURZBACH RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2431
Practice Address - Country:US
Practice Address - Phone:210-647-4671
Practice Address - Fax:210-647-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB101154Medicare UPIN