| Palo Alto Clinic | |
|
9011 Poteet Jourdanton Fwy San Antonio TX 78224-2124 | |
| (210) 921-6010 | |
| (210) 921-6188 |
| Full Name | Palo Alto Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 9011 Poteet Jourdanton Fwy, 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 |
|---|---|
| Palo Alto Clinic 3750 Commercial Ave San Antonio TX 78221-3117 Ph: (210) 334-3715 | Palo Alto Clinic 9011 Poteet Jourdanton Fwy San Antonio TX 78224-2124 Ph: (210) 921-6010 |
| NPI Number | 1730388018 |
|---|---|
| Provider Enumeration Date | 07/16/2007 |
| Last Update Date | 07/16/2009 |
| Medicare PECOS PAC ID | 6800881285 |
|---|---|
| Medicare Enrollment ID | O20071008000099 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730388018 | NPI | - | NPPES |
| 120980101 | Medicaid | TX | |
| 189778701 | Medicaid | TX | |
| 120980105 | Medicaid | TX | |
| 00MT08 | Other | TX | GROUP MEDICARE |
| 120980102 | Medicaid | TX | |
| 120980103 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | HBOCS00758-04-00 (Texas) | Primary |
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