Healthcare Provider Details

I. General information

NPI: 1164529434
Provider Name (Legal Business Name): A2C2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 CENTRAL PKWY S
SAN ANTONIO TX
78232-5021
US

IV. Provider business mailing address

1006 CENTRAL PKWY S
SAN ANTONIO TX
78232-5021
US

V. Phone/Fax

Practice location:
  • Phone: 210-490-9169
  • Fax: 210-545-7740
Mailing address:
  • Phone: 210-490-9169
  • Fax: 210-545-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4193
License Number StateTX

VIII. Authorized Official

Name: DR. DOREEN ANN LEWIS-OVERTON
Title or Position: OWNER
Credential: D.C.
Phone: 210-490-9169