MEDICARE: SPIRE MEDICAL MANAGEMENT, INC

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	H7749	TX

General Provider Information

NPI Number	:	1558638262
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPIRE MEDICAL MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	323 NW 24TH ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3209
Country	:	US
Telephone Number	:	210-438-8055
Fax Number	:	210-979-7843

Provider Business Practice Location Address
First Line	:	323 NW 24TH ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-3209
Country	:	US
Telephone Number	:	210-438-8055
Fax Number	:	210-979-7843

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. CLAY GRUESBECK
Credential	:	MD
Telephone Number	:	210-438-8055

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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