Healthcare Provider Details

I. General information

NPI: 1154372860
Provider Name (Legal Business Name): COMMUNITY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W OLMOS DR
SAN ANTONIO TX
78212-1956
US

IV. Provider business mailing address

210 W OLMOS DR
SAN ANTONIO TX
78212-1956
US

V. Phone/Fax

Practice location:
  • Phone: 210-821-5522
  • Fax: 210-821-5911
Mailing address:
  • Phone: 210-821-5522
  • Fax: 210-821-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. SONYA M. ERB
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 210-805-8102