Healthcare Provider Details

I. General information

NPI: 1275582504
Provider Name (Legal Business Name): METHODIST INPATIENT MANAGEMENT GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8109 FREDERICKSBURG RD
SAN ANTONIO TX
78229-3311
US

IV. Provider business mailing address

8109 FREDERICKSBURG RD
SAN ANTONIO TX
78229-3311
US

V. Phone/Fax

Practice location:
  • Phone: 210-575-8505
  • Fax: 210-575-0167
Mailing address:
  • Phone: 210-575-8505
  • Fax: 210-575-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBERTA S. CLOUD
Title or Position: PRESIDENT
Credential:
Phone: 210-575-8505