Provider Demographics
NPI:1235660507
Name:ADVANCED CLINICIAN SPECIALTY GROUP PLLC
Entity type:Organization
Organization Name:ADVANCED CLINICIAN SPECIALTY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP-BC
Authorized Official - Phone:210-446-8021
Mailing Address - Street 1:17503 LA CANTERA PKWY
Mailing Address - Street 2:104-409
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-8207
Mailing Address - Country:US
Mailing Address - Phone:210-446-8021
Mailing Address - Fax:210-579-6710
Practice Address - Street 1:19338 BABCOCK RD UNIT 108109
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78255-2478
Practice Address - Country:US
Practice Address - Phone:210-446-8021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty