Healthcare Provider Details

I. General information

NPI: 1114559432
Provider Name (Legal Business Name): GUADALUPE REGIONAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 S. STATE HWY 46, SUITE 104
NEW BRAUNFELS TX
78130
US

IV. Provider business mailing address

1215 E COURT ST
SEGUIN TX
78155-5129
US

V. Phone/Fax

Practice location:
  • Phone: 830-433-7815
  • Fax:
Mailing address:
  • Phone: 830-401-7558
  • Fax: 830-401-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSIE PRICHARD
Title or Position: PRACTICE MANAGER
Credential:
Phone: 830-401-7558