MEDICARE: GREATER SA HOUSE CALLS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	363LG0600X	Gerontology Nurse Practitioner
3	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1669701959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER SA HOUSE CALLS, LLC

Provider Business Mailing Address
First Line	:	9531 AUTUMN BREEZE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78254-1969
Country	:	US
Telephone Number	:	210-647-4671
Fax Number	:	210-647-7552

Provider Business Practice Location Address
First Line	:	5309 WURZBACH RD STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-2431
Country	:	US
Telephone Number	:	210-647-4671
Fax Number	:	210-647-7552

Authorized Official
Title or Position	:	OWNER
Name	:	MR. UGHANMWAN TOKUNBOR EFEOVBOKHAN
Credential	:	GNP
Telephone Number	:	210-789-1274

Provider Enumeration Date	:	12/15/2009
Last Update Date	:	03/22/2022

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Directions to “GREATER SA HOUSE CALLS, LLC ” Practice Location

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