Healthcare Provider Details

I. General information

NPI: 1407975618
Provider Name (Legal Business Name): ACCOMPLISHED DIAGNOSTIC MEDICAL INPATIENT TEAM, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18850 REDLAND RD
SAN ANTONIO TX
78259-3570
US

IV. Provider business mailing address

PO BOX 701154
SAN ANTONIO TX
78270-1154
US

V. Phone/Fax

Practice location:
  • Phone: 210-576-5299
  • Fax: 210-490-1931
Mailing address:
  • Phone: 210-576-5299
  • Fax: 210-490-1931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CHRIS MATHIS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 210-490-5547