Basic Information
| Provider Information | |||||||||
| NPI: | 1770601163 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STILLPOINT MEDICAL GROUP P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1934 | ||||||||
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| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782971934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185248786 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2421 WORTH ST | ||||||||
| Address2: | |||||||||
| City: | HEMPHILL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759487215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097873772 | ||||||||
| FaxNumber: | 4097874506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 11/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | RAUL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8185248786 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C3918 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 2084A0401X | G6002 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 2084P0802X | G6002 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Psychiatry | 2084P0800X | G6002 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 08478320 | 05 | TX | MEDICAID | G6002 | 01 | TX | TEXAS MEDICAL LICENSE | OTHER |