MEDICARE: SA HEALTH AND WELLNESS LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1164125274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SA HEALTH AND WELLNESS LLC

Provider Business Mailing Address
First Line	:	1426 SUN MTN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-7358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 S PIEDRAS DR STE 217
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1223
Country	:	US
Telephone Number	:	210-275-1375
Fax Number	:	210-905-0018

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DAMON A. RUNION
Credential	:
Telephone Number	:	210-595-0327

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	10/29/2023

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