Med Management Indiana Pc | |
7272 Wurzbach Rd Ste 601 San Antonio TX 78240-4803 | |
(210) 615-3483 | |
Not Available |
Full Name | Med Management Indiana Pc |
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Speciality | Psychiatry & Neurology |
Location | 7272 Wurzbach Rd Ste 601, San Antonio, Texas |
Authorized Official Name and Position | Riaz Rahman (DIRECTOR & SHAREHOLDER) |
Authorized Official Contact | 3214439924 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Med Management Indiana Pc 7272 Wurzbach Rd Ste 601 San Antonio TX 78240-4803 Ph: (210) 615-3483 | Med Management Indiana Pc 7272 Wurzbach Rd Ste 601 San Antonio TX 78240-4803 Ph: (210) 615-3483 |
NPI Number | 1225519333 |
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Provider Enumeration Date | 08/27/2018 |
Last Update Date | 05/12/2020 |
Certification Date | 05/12/2020 |
Medicare PECOS PAC ID | 5698027266 |
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Medicare Enrollment ID | O20181009002497 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225519333 | NPI | - | NPPES |
01076161A | Other | IN | LICENSE |
Taxonomy | Type | License (State) | Status |
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2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
Provider Name | Kelly L Kelly |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1003228446 PECOS PAC ID: 4385867787 Enrollment ID: I20140603000350 |
Provider Name | Riaz Rahman |
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Provider Type | Practitioner - Geriatric Psychiatry |
Provider Identifiers | NPI Number: 1275630717 PECOS PAC ID: 8729077235 Enrollment ID: I20181009002677 |
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