MEDICARE: MICHAEL J. MCMAINS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	21260	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87217A	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1013027044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J. MCMAINS PH.D.

Provider Business Mailing Address
First Line	:	1419 BROOK MDWS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5151
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 BROOKLYN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4804
Country	:	US
Telephone Number	:	210-472-2090
Fax Number	:	210-472-2062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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