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General NPI Number Information
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NPI Number | 1851600688
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Entity Type | Organization
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Legal Business Name | MEDTRONIX HEALTHCARE INC
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Dates
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Enumeration Date | 09/28/2010
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 3425 WURZBACH RD
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City | SAN ANTONIO
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State | TX
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Zip | 78238-4069
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Country | US
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Telephone | 210-870-0923
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Fax |
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Provider Business Mailing Address
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Address Line | 4114 MEDICAL DR SUITE 9301
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5607
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Country | US
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Telephone | 210-870-0923
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAM MICHAELS
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Credential | MD
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Telephone | 210-870-0923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | L0869
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | L0869
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License Number State | TX
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