Provider Demographics
NPI:1720086499
Name:SAN ANTONIO-MMC, P.A.
Entity Type:Organization
Organization Name:SAN ANTONIO-MMC, P.A.
Other - Org Name:MAC GREGOR MEDICAL CENTER- SAN ANTONIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SENGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-690-2273
Mailing Address - Street 1:PO BOX 2448
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2448
Mailing Address - Country:US
Mailing Address - Phone:210-690-2273
Mailing Address - Fax:210-694-5172
Practice Address - Street 1:9969 FREDERICKSBURG RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4106
Practice Address - Country:US
Practice Address - Phone:210-690-2273
Practice Address - Fax:210-581-8209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
128959OtherAETNA
0089EBOtherBCBS
TX0809154-01Medicaid
16167-0001OtherPACIFICARE
TX0809154-01Medicaid
16167-0001OtherPACIFICARE