=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922595537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOTALNO MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2018
-----------------------------------------------------
Last Update Date | 05/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12030 BANDERA RD STE 128
-----------------------------------------------------
City | HELOTES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78023-4776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-379-1501
-----------------------------------------------------
Fax | 210-579-9223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14422 CONTOUR PL
-----------------------------------------------------
City | HELOTES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78023-4598
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-379-1501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RICHARD SPITZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 210-379-1501
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------