MEDICARE: MACIAS HEALTHCARE CLINIC

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	261QP2300X	Primary Care Clinic/Center		TX

General Provider Information

NPI Number	:	1053701284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MACIAS HEALTHCARE CLINIC

Provider Business Mailing Address
First Line	:	7055 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1266
Country	:	US
Telephone Number	:	210-281-5585
Fax Number	:	210-281-4498

Provider Business Practice Location Address
First Line	:	7055 BANDERA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-1266
Country	:	US
Telephone Number	:	210-281-5585
Fax Number	:	210-281-4498

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT/OWNER
Name	:	MR. MIGUEL EUGENIO MACIAS
Credential	:	PA
Telephone Number	:	210-281-5585

Provider Enumeration Date	:	01/26/2015
Last Update Date	:	01/26/2015

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