Glen Medellin
M.D. | Pediatrics | Male
Glen Medellin, M.D. is a San Antonio, Texas based Pediatric doctor with medical specialization in
General Pediatrics.
Current practice location of Glen Medellin is
903 W Martin St, San Antonio, Texas - 78207-0903. He can be contacted on phone at
210-358-9658 and fax number 210-358-3450.
Glen Medellin is a sole proprietor of his business.
NPI number (Unique professional ID) for Glen Medellin is
1689686610 which was assigned by NPPES on 11 Aug, 2006 and it was last updated on 22 Dec, 2015.
Glen Medellin license number is
K3796 for Pediatrics (208000000X) in Texas.
Glen Medellin is a pediatrician who is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
Complete Profile:
Glen Medellin basic information including his official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics |
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| Provider Name : | Glen Medellin |
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| Credential : | M.D. |
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| Gender : | Male |
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Business Address:
Glen Medellin address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 903 W Martin St
San Antonio, TX, 78207-0903
United States |
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| Phone Number : | 210-358-9658 |
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| Fax Number : | 210-358-3450 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1689686610 |
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| NPI Entity Type : | Individual |
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| First Enrolment Date : | 11 Aug, 2006 |
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| Last Updated On : | 22 Dec, 2015 |
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Medicare Participation:
Glen Medellin participates in medicare and accepts medicare insurance either directly or through association with group practice or medical facility.
| Medicare PECOS ID : | 0143292680 |
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| Medicare Enrollment ID : | I20040806000374 |
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| Primary Specialty : | Pediatric Medicine |
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| Medical School : | University Of Texas Medical Branch At Galveston |
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| Graduation Year : | 1994 |
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| Accepts Medicare? | Yes. Glen Medellin accepts medicare insurance. |
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Group Practice Association:
Glen Medellin is associated with following Group Practice Organizations. Group practices are practice of medicine by a group of physicians who share their premises and other resources. Following list states all the group name with which Glen Medellin is associated with along with the number of members in that group. He may also accept medicare indirectly via these group practices.
| Organisation Name : | Group Practice ID | No. of Members | Practice Address | Group Accepts Medicare |
|---|
| Community Medicine Associates | 7719979509 | 230 | 4502 Medical Dr
San Antonio, TX - 782294402 | Yes |
Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Glen Medellin are as mentioned. Primary taxonomy code for Glen Medellin, M.D. is
208000000X (Pediatrics).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 208000000X | Pediatrics | Yes | K3796 | TX |
Legacy Identifiers:
Other legacy medical identifiers of Glen Medellin such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 125095307 | Other | TX | CSHCN |
| 125095309 | Other | TX | MEDICAID CSHCN |
| 125095308 | MEDICAID | TX | |
| 125095307 | MEDICAID | TX | |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | Po Box 87
San Antonio, TX, 78291-0087
United States |
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| Phone Number : | 210-358-9172 |
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| Fax Number : | 210-358-9183 |
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Business Location:
Patients can refer following map for directions to
Glen Medellin practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 January, 2024.