MEDICARE: ALAMO CITY MEDICAL GROUP, 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	207Q00000X	Family Medicine 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	00N29F	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1558354092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMO CITY MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	1045 CENTRAL PKWY N
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5085
Country	:	US
Telephone Number	:	512-298-5343
Fax Number	:

Provider Business Practice Location Address
First Line	:	1045 CENTRAL PARKWAY NORTH
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5024
Country	:	US
Telephone Number	:	210-541-4500
Fax Number	:	210-541-4508

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT G HASSETT
Credential	:	M.D.
Telephone Number	:	210-298-5343

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	02/02/2015

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