Provider Demographics
NPI:1174882369
Name:JOHN ADAMS, MD PSYCHIATRY PLLC
Entity type:Organization
Organization Name:JOHN ADAMS, MD PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-758-4515
Mailing Address - Street 1:1141 NORTH LOOP 1604
Mailing Address - Street 2:EAST # 105-158
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:330-758-4512
Mailing Address - Fax:330-782-4750
Practice Address - Street 1:17720 CORPORATE WOODS DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259
Practice Address - Country:US
Practice Address - Phone:210-491-9400
Practice Address - Fax:210-491-3517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8465273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX613972Medicaid
TX206544301Medicare PIN