MEDICARE: SECOND BAPTIST CHURCH

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1922609361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND BAPTIST CHURCH

Provider Business Mailing Address
First Line	:	3310 E COMMERCE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-1220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 E COMMERCE ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-1220
Country	:	US
Telephone Number	:	210-227-2605
Fax Number	:	210-227-7419

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ALLEN KEITH JACKSON
Credential	:
Telephone Number	:	210-227-2605

Provider Enumeration Date	:	11/03/2020
Last Update Date	:	11/03/2020

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Directions to “SECOND BAPTIST CHURCH ” Practice Location

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