MEDICARE: SOUTH TEXAS HEALTH & 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1932612058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS HEALTH & WELLNESS, LLC

Provider Business Mailing Address
First Line	:	9614 FRENCH WALK
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4584
Country	:	US
Telephone Number	:	405-761-3419
Fax Number	:

Provider Business Practice Location Address
First Line	:	6391 DE ZAVALA RD STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2159
Country	:	US
Telephone Number	:	405-761-3419
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHASITY LYNCH
Credential	:	FNP-C
Telephone Number	:	405-761-3419

Provider Enumeration Date	:	11/10/2017
Last Update Date	:	11/10/2017

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