Provider Demographics
NPI:1194177246
Name:4 YOUR HEALTH MA, LLC
Entity type:Organization
Organization Name:4 YOUR HEALTH MA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARITA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAMMEKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:210-482-0047
Mailing Address - Street 1:18866 STONE OAK PKWY
Mailing Address - Street 2:103-136
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4180
Mailing Address - Country:US
Mailing Address - Phone:210-482-0047
Mailing Address - Fax:
Practice Address - Street 1:18866 STONE OAK PKWY
Practice Address - Street 2:103-136
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4180
Practice Address - Country:US
Practice Address - Phone:210-482-0047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2970208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164479523OtherINDIVIDUAL NPI
TXI47174Medicare UPIN