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General NPI Number Information
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NPI Number | 1881813806
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Entity Type | Organization
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Legal Business Name | KELLCY MEDICAL GROUP, P.A.
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 204 CAMP WILLOW RD
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-1805
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Country | US
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Telephone | 830-627-9208
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Fax | 830-625-0353
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Provider Business Mailing Address
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Address Line | 206 CAMP WILLOW RD
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City | NEW BRAUNFELS
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State | TX
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Zip | 78130-1805
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Country | US
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Telephone | 830-620-7744
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Fax | 830-625-0353
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Authorized Official
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Title or Position | BILLING ADMIN
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Name | MARTHA BRANDENBURG
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Credential |
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Telephone | 830-627-9208
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | K5088
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K5088
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License Number State | TX
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