MEDICARE: ALAMO SURGICAL 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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1982237574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAMO SURGICAL MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	PO BOX 2550
Second Line	:
City	:	ROWLETT
State	:	TX
Zip	:	75030-2550
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Provider Business Practice Location Address
First Line	:	4590 LOCKHILL SELMA RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2073
Country	:	US
Telephone Number	:	214-227-2457
Fax Number	:	214-764-0880

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN KIESER
Credential	:
Telephone Number	:	214-396-7989

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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