MEDICARE: ADYA PHYSICIAN SERVICES PLLC

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	208M00000X	Hospitalist Physician		TX

General Provider Information

NPI Number	:	1902354152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADYA PHYSICIAN SERVICES PLLC

Provider Business Mailing Address
First Line	:	1806 ESTONIA CV
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-5015
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1806 ESTONIA CV
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-5015
Country	:	US
Telephone Number	:	210-374-8016
Fax Number	:	210-485-6253

Authorized Official
Title or Position	:	CEO
Name	:	SUNIL KAMBI
Credential	:
Telephone Number	:	210-374-8016

Provider Enumeration Date	:	09/16/2016
Last Update Date	:	09/21/2016

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