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Organization
LYTLE FAMILY PRACTICE PA
Active
Organization
LYTLE FAMILY PRACTICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENDON SALDIVAR HACK MD (PRESIDENT)
(830) 709-9960
Entity
Organization
Contact information
Practice address
19432 DAVIS ST, LYTLE, TX 78052-1601
(830) 709-9960
Mailing address
PO BOX 324, VON ORMY, TX 78073-0324
(830) 709-9960
(830) 709-9962
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K7753
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0057NC
BCBS
TX
Enumeration date
10/03/2006
Last updated
08/22/2020
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