MEDICARE: TMS PSYCHIATRIC SERVICES OF AMERICA, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1053098301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMS PSYCHIATRIC SERVICES OF AMERICA, PLLC

Provider Business Mailing Address
First Line	:	12662 OLD WICK CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1936
Country	:	US
Telephone Number	:	210-365-1877
Fax Number	:

Provider Business Practice Location Address
First Line	:	12662 OLD WICK CIR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1936
Country	:	US
Telephone Number	:	210-365-1877
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	MARSHALL SMITH
Credential	:	MD
Telephone Number	:	210-365-1877

Provider Enumeration Date	:	06/29/2023
Last Update Date	:	06/29/2023

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