MEDICARE: NORTH CENTRAL FAMILY CLINIC

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	207Q00000X	Family Medicine Physician	H8061	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H8061	OTHER	TX	TX LICENSE
2	00830N	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1447438171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH CENTRAL FAMILY CLINIC

Provider Business Mailing Address
First Line	:	14701 HWY 281 N STE 240
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4355
Country	:	US
Telephone Number	:	210-402-3856
Fax Number	:	210-403-2561

Provider Business Practice Location Address
First Line	:	14701 HWY 281 N STE 240
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-4355
Country	:	US
Telephone Number	:	210-402-3856
Fax Number	:	210-403-2561

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN GARTON
Credential	:	DO
Telephone Number	:	210-402-3856

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/21/2008

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Directions to “NORTH CENTRAL FAMILY CLINIC ” Practice Location

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