Provider Demographics
NPI:1962414888
Name:DOC IN THE BOX PA
Entity type:Organization
Organization Name:DOC IN THE BOX PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THIMIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:PARTALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-558-0991
Mailing Address - Street 1:2425 BABCOCK RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4898
Mailing Address - Country:US
Mailing Address - Phone:210-558-0991
Mailing Address - Fax:210-558-0520
Practice Address - Street 1:2425 BABCOCK RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4898
Practice Address - Country:US
Practice Address - Phone:210-558-0991
Practice Address - Fax:210-558-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203691501Medicaid
TX00525YMedicare PIN