Provider Demographics
NPI:1871985861
Name:AMBULATORY STRATEGIES PHYSICIAN GROUP
Entity type:Organization
Organization Name:AMBULATORY STRATEGIES PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GENERALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-282-2111
Mailing Address - Street 1:PO BOX 572488
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84157-2488
Mailing Address - Country:US
Mailing Address - Phone:469-282-2172
Mailing Address - Fax:
Practice Address - Street 1:1201 S MAIN ST STE 118
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2839
Practice Address - Country:US
Practice Address - Phone:830-815-1081
Practice Address - Fax:810-815-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-27
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QU0200X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty