Provider Demographics
NPI:1730214396
Name:TEXAS HEALTHNET MEDICAL CLINIC LTD.
Entity type:Organization
Organization Name:TEXAS HEALTHNET MEDICAL CLINIC LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-653-7444
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78293-0806
Mailing Address - Country:US
Mailing Address - Phone:210-653-7444
Mailing Address - Fax:210-653-7456
Practice Address - Street 1:8715 VILLAGE DR
Practice Address - Street 2:SUITE 612
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5405
Practice Address - Country:US
Practice Address - Phone:210-653-7444
Practice Address - Fax:210-653-7456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS HEALTHNET MEDICAL CLINIC LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-23
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140228133Medicaid
TX0020PCOtherBCBS OF TEXAS
TX00926ZMedicare PIN