MEDICARE: TEXAS INSTITUTE OF GASTROENTEROLOGY ASSOCIATES , 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	207RG0100X	Gastroenterology Physician

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	0028NP	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1538267067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS INSTITUTE OF GASTROENTEROLOGY ASSOCIATES , PA

Provider Business Mailing Address
First Line	:	19284 STONE OAK PKWY STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3474
Country	:	US
Telephone Number	:	210-268-0120
Fax Number	:	210-268-0170

Provider Business Practice Location Address
First Line	:	19284 STONE OAK PKWY STE 104
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3474
Country	:	US
Telephone Number	:	210-268-0120
Fax Number	:	210-268-0170

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOYCELYN M THEARD
Credential	:	MD
Telephone Number	:	210-268-0120

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/03/2023

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Directions to “TEXAS INSTITUTE OF GASTROENTEROLOGY ASSOCIATES , PA ” Practice Location

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