=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447438171
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH CENTRAL FAMILY CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2008
-----------------------------------------------------
Last Update Date | 02/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14701 HWY 281 N STE 240
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-402-3856
-----------------------------------------------------
Fax | 210-403-2561
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14701 HWY 281 N STE 240
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78232-4355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-402-3856
-----------------------------------------------------
Fax | 210-403-2561
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SUSAN GARTON
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 210-402-3856
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | H8061
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------