Provider Demographics
NPI:1780880666
Name:SARA D MCCAMISH MD PA
Entity type:Organization
Organization Name:SARA D MCCAMISH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-733-1802
Mailing Address - Street 1:4125 MCCULLOUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-1903
Mailing Address - Country:US
Mailing Address - Phone:210-826-2822
Mailing Address - Fax:210-826-3372
Practice Address - Street 1:4125 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1903
Practice Address - Country:US
Practice Address - Phone:210-826-2822
Practice Address - Fax:210-826-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7478173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00967XMedicare ID - Type UnspecifiedGROUP
TXH71209Medicare UPIN