Provider Demographics
NPI:1154987121
Name:ALAMO PHYSICIAN SERVICES, PLLC
Entity type:Organization
Organization Name:ALAMO PHYSICIAN SERVICES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PUJITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEPYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-753-0744
Mailing Address - Street 1:5460 BABCOCK RD STE 120-C
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3901
Mailing Address - Country:US
Mailing Address - Phone:210-753-0744
Mailing Address - Fax:210-783-8444
Practice Address - Street 1:5460 BABCOCK RD STE 120-C
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3901
Practice Address - Country:US
Practice Address - Phone:210-753-0744
Practice Address - Fax:210-783-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX399218201Medicaid