MEDICARE: CICLINTON RHEUMATOLOGY PLLC

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	207RR0500X	Rheumatology Physician	M8609	TX

General Provider Information

NPI Number	:	1083851281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CICLINTON RHEUMATOLOGY PLLC

Provider Business Mailing Address
First Line	:	11844 BANDERA RD # 706
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4132
Country	:	US
Telephone Number	:	210-591-0688
Fax Number	:	210-858-0088

Provider Business Practice Location Address
First Line	:	18585 SIGMA RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4204
Country	:	US
Telephone Number	:	210-591-0688
Fax Number	:	210-858-0088

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. CHELSEA I. CLINTON
Credential	:	M.D.
Telephone Number	:	210-591-0688

Provider Enumeration Date	:	01/10/2009
Last Update Date	:	09/26/2010

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