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General NPI Number Information
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NPI Number | 1407215122
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Entity Type | Organization
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Legal Business Name | TEJAS VISITING PHYSICIANS, LLC.
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Dates
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Enumeration Date | 02/23/2016
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 2795 BULVERDE RD STE A
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City | BULVERDE
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State | TX
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Zip | 78163-2195
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Country | US
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Telephone | 210-365-7987
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Fax |
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Provider Business Mailing Address
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Address Line | 202 DILLARD LN
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City | BERGHEIM
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State | TX
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Zip | 78004-1932
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALLISON SMOOT
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Credential | RN, BSN
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Telephone | 210-365-7987
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | L6877
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License Number State | TX
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