Basic Information
| Provider Information | |||||||||
| NPI: | 1174882369 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHN ADAMS, MD PSYCHIATRY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1141 NORTH LOOP 1604 | ||||||||
| Address2: | EAST # 105-158 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307584512 | ||||||||
| FaxNumber: | 3307824750 | ||||||||
| Practice Location | |||||||||
| Address1: | 17720 CORPORATE WOODS DRIVE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104919400 | ||||||||
| FaxNumber: | 2104913517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2012 | ||||||||
| LastUpdateDate: | 05/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | ADAMS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3307584515 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | M8465 | TX | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 613972 | 05 | TX | MEDICAID |