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General NPI Number Information
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NPI Number | 1487927380
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Entity Type | Organization
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Legal Business Name | AEGIS MEDCARE, LLC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 520 CAMDEN ST SUITE B
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1924
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Country | US
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Telephone | 210-884-6047
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Fax | 210-499-0615
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Provider Business Mailing Address
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Address Line | 520 CAMDEN ST SUITE B
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1924
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Country | US
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Telephone | 210-884-6047
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Fax | 210-499-0615
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. RODERICK A POTTS
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Credential |
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Telephone | 210-884-6047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | H1945
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License Number State | TX
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