Provider Demographics
NPI:1720703374
Name:LIFE CHOICES MEDICAL CLINIC
Entity Type:Organization
Organization Name:LIFE CHOICES MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PENNE
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:JASTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:210-543-7200
Mailing Address - Street 1:3234 NORTHWESTERN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-4043
Mailing Address - Country:US
Mailing Address - Phone:210-543-7200
Mailing Address - Fax:210-647-9825
Practice Address - Street 1:700 S ZARZAMORA ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5255
Practice Address - Country:US
Practice Address - Phone:210-543-7200
Practice Address - Fax:210-647-9825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFE CHOICES MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health