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Organization

PAIN & NEUROMUSCULAR CLINIC OF TEXAS , P.A.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. SAMUEL MICHAEL THEAGENE M.D. (PRESIDENT)
(210) 826-2311
Entity
Organization

Contact information

Practice address
6100 BANDERA RD, 710, SAN ANTONIO, TX 78238-1652
(210) 826-2311
(210) 826-2641
Mailing address
PO BOX 29097, SAN ANTONIO, TX 78229-0097
(210) 826-2311
(210) 826-2641

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J7690
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0074DJ
BLUE CROSS BLUE SHIELD
TX
Enumeration date
04/17/2007
Last updated
08/22/2020
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