Healthcare Provider Details

I. General information

NPI: 1033355151
Provider Name (Legal Business Name): RIVER CITY MEDICAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 CAMDEN ST
SAN ANTONIO TX
78215-1925
US

IV. Provider business mailing address

515 CAMDEN ST
SAN ANTONIO TX
78215-1925
US

V. Phone/Fax

Practice location:
  • Phone: 210-599-8300
  • Fax: 210-599-8853
Mailing address:
  • Phone: 210-599-8300
  • Fax: 210-599-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CELESTE JUAREZ
Title or Position: BILLING MANAGER
Credential:
Phone: 210-599-8300