MEDICARE: PRIMARY MED CLINIC PA

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	207R00000X	Internal Medicine Physician	N4060	TX

General Provider Information

NPI Number	:	1083959324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY MED CLINIC PA

Provider Business Mailing Address
First Line	:	7003 S NEW BRAUNFELS AVE # 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-4588
Country	:	US
Telephone Number	:	210-616-1317
Fax Number	:

Provider Business Practice Location Address
First Line	:	7003 S NEW BRAUNFELS AVE # 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-4588
Country	:	US
Telephone Number	:	210-616-1317
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MAHER SALOUM
Credential	:	M.D.
Telephone Number	:	210-616-1317

Provider Enumeration Date	:	11/27/2012
Last Update Date	:	02/27/2013

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Directions to “PRIMARY MED CLINIC PA ” Practice Location

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