MEDICARE: SOUTHTOWN PSYCHIATRY 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1457167702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHTOWN PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	909 NE LOOP 410 STE 600
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1309
Country	:	US
Telephone Number	:	210-343-5121
Fax Number	:

Provider Business Practice Location Address
First Line	:	909 NE LOOP 410 STE 600
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1309
Country	:	US
Telephone Number	:	210-343-5121
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASON CLAY MILLER
Credential	:
Telephone Number	:	210-460-0070

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	04/08/2026

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