Provider Demographics
NPI:1982322111
Name:ADHD PLUS
Entity type:Organization
Organization Name:ADHD PLUS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PENKAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-403-2343
Mailing Address - Street 1:4940 BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5732
Mailing Address - Country:US
Mailing Address - Phone:210-403-2343
Mailing Address - Fax:210-403-2350
Practice Address - Street 1:4940 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-5732
Practice Address - Country:US
Practice Address - Phone:210-403-2343
Practice Address - Fax:210-403-2350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADHD PLUS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-15
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12151709Medicaid