Basic Information
| Provider Information | |||||||||
| NPI: | 1447438171 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH CENTRAL FAMILY CLINIC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14701 HWY 281 N STE 240 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782324355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104023856 | ||||||||
| FaxNumber: | 2104032561 | ||||||||
| Practice Location | |||||||||
| Address1: | 14701 HWY 281 N STE 240 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782324355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104023856 | ||||||||
| FaxNumber: | 2104032561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2008 | ||||||||
| LastUpdateDate: | 02/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | GARTON | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2104023856 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | H8061 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | H8061 | 01 | TX | TX LICENSE | OTHER | 00830N | 01 | TX | BCBS | OTHER |