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General NPI Number Information
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NPI Number | 1346848223
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Entity Type | Organization
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Legal Business Name | DR. MARY DIANE WAY
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 1811 BURR OAK LN
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City | ADKINS
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State | TX
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Zip | 78101-2606
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Country | US
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Telephone | 210-364-2430
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 BURR OAK LN
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City | ADKINS
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State | TX
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Zip | 78101-2606
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Country | US
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Telephone | 210-364-2430
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BARBARA A MACCALLUM-SCHMIDT
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Credential | BILLING
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Telephone | 210-623-0140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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