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General NPI Number Information
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NPI Number | 1962583930
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Entity Type | Organization
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Legal Business Name | TRACY L SCHILLERSTROM M.D., P.A.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 9150 HUEBNER RD STE 255
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1545
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Country | US
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Telephone | 210-641-1800
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Fax | 210-641-1816
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Provider Business Mailing Address
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Address Line | 7222 TIMBERLEAF ST
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City | SAN ANTONIO
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State | TX
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Zip | 78238-1350
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Country | US
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Telephone | 210-680-5543
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Fax | 210-641-1816
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Authorized Official
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Title or Position | OWNER
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Name | TRACY LYNN SCHILLERSTROM
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Credential | M.D.
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Telephone | 210-680-5543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | M3083
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License Number State | TX
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