Healthcare Provider Details

I. General information

NPI: 1578873717
Provider Name (Legal Business Name): GUADALUPE REGIONAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 06/12/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MEDICAL
SEGUIN TX
78155-5392
US

IV. Provider business mailing address

1215 E COURT ST
SEGUIN TX
78155-5129
US

V. Phone/Fax

Practice location:
  • Phone: 830-401-7558
  • Fax:
Mailing address:
  • Phone: 830-379-2411
  • Fax: 830-401-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSIE PRICHARD
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 830-401-7558