Healthcare Provider Details

I. General information

NPI: 1962041558
Provider Name (Legal Business Name): SYNERGENX HEALTH - ALAMO RANCH SAN ANTONIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CULEBRA COMMONS, PHASE II, W LOOP 1604 N AND CULEBRA RD SUITE 204
SAN ANTONIO TX
78254
US

IV. Provider business mailing address

16131 N ELDRIDGE PKWY STE 100
TOMBALL TX
77377-9130
US

V. Phone/Fax

Practice location:
  • Phone: 281-429-8523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WELTON WILSON
Title or Position: MANAGER
Credential:
Phone: 281-429-8523