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General NPI Number Information
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NPI Number | 1568619005
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Entity Type | Organization
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Legal Business Name | IMED HEALTHCARE ASSOCIATES, PLLC
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 255 E SONTERRA BLVD STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4076
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Country | US
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Telephone | 210-404-0000
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Fax | 210-404-2813
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Provider Business Mailing Address
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Address Line | 255 E SONTERRA BLVD STE 100
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4076
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Country | US
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Telephone | 210-404-0000
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Fax | 210-404-2813
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. ROBERTA S. CLOUD
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Credential |
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Telephone | 210-575-8505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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