MEDICARE: HILL COUNTRY CONVENIENT FAMILY HEALTHCARE 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	207Q00000X	Family Medicine Physician	M2297	TX

General Provider Information

NPI Number	:	1316213051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILL COUNTRY CONVENIENT FAMILY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	18419 CROSSTIMBER
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4526
Country	:	US
Telephone Number	:	210-912-2020
Fax Number	:	830-331-8013

Provider Business Practice Location Address
First Line	:	18419 CROSSTIMBER
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4526
Country	:	US
Telephone Number	:	210-912-2020
Fax Number	:	830-331-8013

Authorized Official
Title or Position	:	GROUP MAMAGER
Name	:	MR. RICHARD DELGADO
Credential	:
Telephone Number	:	210-260-1803

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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