| Centromed Southside Medical Clinic | |
|
3750 Commercial Ave San Antonio TX 78221-3117 | |
| (210) 334-3700 | |
| (210) 922-0162 |
| Full Name | Centromed Southside Medical Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 3750 Commercial Ave, San Antonio, Texas |
| Authorized Official Name and Position | Chuck Walzel (CFO) |
| Authorized Official Contact | 2103343724 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Centromed Southside Medical Clinic 3750 Commercial Ave San Antonio TX 78221-3117 Ph: (210) 334-3700 | Centromed Southside Medical Clinic 3750 Commercial Ave San Antonio TX 78221-3117 Ph: (210) 334-3700 |
| NPI Number | 1104998749 |
|---|---|
| Provider Enumeration Date | 11/15/2006 |
| Last Update Date | 08/18/2011 |
| Medicare PECOS PAC ID | 6800881285 |
|---|---|
| Medicare Enrollment ID | O20050303000520 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104998749 | NPI | - | NPPES |
| 00MT08 | Other | TX | GROUP MEDICARE |
| 120980106 | Medicaid | TX | |
| G60232-01 | Other | TX | DELTA DENTAL |
| 120980102 | Medicaid | TX | |
| 120980103 | Medicaid | TX | |
| 120980101 | Medicaid | TX |
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