MEDICARE: SAMUEL R NEELEY MD 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	261QM2500X	Medical Specialty Clinic/Center	E8757	TX
2	208M00000X	Hospitalist Physician	E8757	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0015PZ	OTHER	TX	BLUE CROSS
2	004203225	OTHER	TX	AETNA HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649391632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL R NEELEY MD PA

Provider Business Mailing Address
First Line	:	PO BOX 700447
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78270-0447
Country	:	US
Telephone Number	:	210-525-1668
Fax Number	:	210-525-1669

Provider Business Practice Location Address
First Line	:	12446 WEST AVE
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78216-2517
Country	:	US
Telephone Number	:	210-525-1668
Fax Number	:	210-525-1669

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. SAMUEL ROBERT NEELEY
Credential	:	MD
Telephone Number	:	210-525-1668

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	05/12/2015

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