Provider Demographics
NPI:1841557642
Name:FAMILY MEDICAL HOME, PLLC
Entity type:Organization
Organization Name:FAMILY MEDICAL HOME, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:ALEJANDRO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-680-8081
Mailing Address - Street 1:9179 GRISSOM RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2810
Mailing Address - Country:US
Mailing Address - Phone:210-680-8081
Mailing Address - Fax:210-680-3133
Practice Address - Street 1:9179 GRISSOM RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-2810
Practice Address - Country:US
Practice Address - Phone:210-680-8081
Practice Address - Fax:210-680-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty