Provider Demographics
NPI:1669597365
Name:ALAMO CITY MEDICAL GROUP
Entity type:Organization
Organization Name:ALAMO CITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF THERAPIST TESTING CENTER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:210-587-4606
Mailing Address - Street 1:3453 N PANAM EXPY
Mailing Address - Street 2:SUITE 207B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78219-2333
Mailing Address - Country:US
Mailing Address - Phone:210-587-4606
Mailing Address - Fax:210-298-2658
Practice Address - Street 1:3453 N PANAM EXPY
Practice Address - Street 2:SUITE 207B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-2333
Practice Address - Country:US
Practice Address - Phone:210-587-4606
Practice Address - Fax:210-298-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204219261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center