MEDICARE: BEXARAID,LLC.

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	246R00000X	Pathology Technician

General Provider Information

NPI Number	:	1437767795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEXARAID,LLC.

Provider Business Mailing Address
First Line	:	110 E HOUSTON ST # 7TH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78205-2990
Country	:	US
Telephone Number	:	210-387-4059
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 BROADWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78215-1117
Country	:	US
Telephone Number	:	830-582-4029
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MEGHAN ALEXANDRA GARZA
Credential	:
Telephone Number	:	830-582-4029

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	07/22/2020

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