Organization
PHOENIX MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANAND W. MEHENDALE M.D. (PRESIDENT)
(830) 895-7675
Entity
Organization
Contact information
Practice address
222 SIDNEY BAKER SOUTH, SUITE 500, KERRVILLE, TX 78028-5900
(830) 895-7675
(830) 896-3082
Mailing address
222 SIDNEY BAKER SOUTH, SUITE 500, KERRVILLE, TX 78028-5900
(830) 895-7675
(830) 896-3082
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
G1112
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00564K
MEDICARE PTAN
TX
01
—
0093CZ
BLUE CROSS BLUE SHIELD
TX
05
—
080790101
—
TX
01
—
CJ3940
RAILROAD MEDICARE
TX
Enumeration date
05/12/2006
Last updated
09/08/2011
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