Provider Demographics
NPI:1053701284
Name:MACIAS HEALTHCARE CLINIC
Entity type:Organization
Organization Name:MACIAS HEALTHCARE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:EUGENIO
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:210-281-5585
Mailing Address - Street 1:7055 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1266
Mailing Address - Country:US
Mailing Address - Phone:210-281-5585
Mailing Address - Fax:210-281-4498
Practice Address - Street 1:7055 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1266
Practice Address - Country:US
Practice Address - Phone:210-281-5585
Practice Address - Fax:210-281-4498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care