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General NPI Number Information
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NPI Number | 1033245923
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Entity Type | Organization
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Legal Business Name | MCKENNA MEDICAL GROUP
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 921 LAKEVIEW BLVD
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-4135
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Country | US
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Telephone | 210-620-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 921 LAKEVIEW BLVD
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-4135
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Country | US
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Telephone | 210-620-7744
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Fax |
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Authorized Official
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Title or Position | V.P. PHYSICIAN SERVICES
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Name | MRS. WENDY BRUNS
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Credential |
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Telephone | 830-606-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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