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NPI Code Detail

MEDICARE: KOMEDIX

MEDICARE: KOMEDIX
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
1261QP2300XPrimary Care Clinic/Center

General Provider Information

NPI Number : 1427458298
Entity Type Code : Organization
Provider Name (Legal Business Name) : KOMEDIX
Provider Business Mailing Address
First Line : 2323 BUENA VISTA ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78207-3704
Country : US
Telephone Number : 830-708-8182
Fax Number :
Provider Business Practice Location Address
First Line : 189 E AUSTIN ST
Second Line : SUITE #106
City : NEW BRAUNFELS
State : TX
Zip : 78130-4104
Country : US
Telephone Number : 830-708-8182
Fax Number :
Authorized Official
Title or Position : COO
Name : MR. ROGER DALE KELLY
Credential :
Telephone Number : 830-708-8182
Provider Enumeration Date : 08/29/2014
Last Update Date : 08/29/2014

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Directions to “KOMEDIX ” Practice Location

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