MEDICARE: HEALTH GROUP PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171000000X	Military Health Care Provider
2	103T00000X	Psychologist
3	261QP2300X	Primary Care Clinic/Center
4	261QU0200X	Urgent Care Clinic/Center
5	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1619538089
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH GROUP PLLC

Provider Business Mailing Address
First Line	:	2515 CASTROVILLE RD STE 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-3361
Country	:	US
Telephone Number	:	210-800-1980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 CASTROVILLE RD STE 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-3361
Country	:	US
Telephone Number	:	210-800-1980
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. CHRISTOPHER JAMES BONNET
Credential	:	FNP
Telephone Number	:	210-800-1980

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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