MEDICARE: WEST KIRK MEDICAL PRACTICE, PA

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	261QP2300X	Primary Care Clinic/Center	E7516	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5903	OTHER	TX	AETNA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	8K1570	OTHER	TX	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508054842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST KIRK MEDICAL PRACTICE, PA

Provider Business Mailing Address
First Line	:	711 KIRK PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78226-1416
Country	:	US
Telephone Number	:	210-227-9408
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 KIRK PL
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78226-1416
Country	:	US
Telephone Number	:	210-227-9408
Fax Number	:

Authorized Official
Title or Position	:	M.D.
Name	:	LEONEL TANO
Credential	:
Telephone Number	:	210-227-9408

Provider Enumeration Date	:	10/11/2007
Last Update Date	:	09/16/2014

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Directions to “WEST KIRK MEDICAL PRACTICE, PA ” Practice Location

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