Provider Demographics
NPI:1861584492
Name:JCMLR, PA
Entity type:Organization
Organization Name:JCMLR, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THIMIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTALAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DACNB
Authorized Official - Phone:210-798-7246
Mailing Address - Street 1:2425 BABCOCK RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4895
Mailing Address - Country:US
Mailing Address - Phone:210-520-7246
Mailing Address - Fax:210-520-9773
Practice Address - Street 1:2425 BABCOCK RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4895
Practice Address - Country:US
Practice Address - Phone:210-520-7246
Practice Address - Fax:210-520-9773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0001GNOtherBC/BS OF TX