Pro-Care Spine Center, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

N1732 Issued in TX

Legal business name

PRO-CARE SPINE CENTER, LLC

Practice address

9502 Huebner Rd
Suite 102
San Antonio, TX 78240-1548

Phone

(512) 371-7478

NPI assigned

Sep 18, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brent Boecking

Title

Director of Marketing and Operation

Phone

(512) 371-7478

Specialties & licenses 4

Addresses

Other names 1

• Pro-Care Medical Center Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1457500035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 W 39TH 1/2 ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787564005",
            "telephone_number": "512-371-7478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9502 HUEBNER RD",
            "address_2": "SUITE 102",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782401548",
            "telephone_number": "512-371-7478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-CARE SPINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-18",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "BOECKING",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "DIRECTOR OF MARKETING AND OPERATION",
        "authorized_official_telephone_number": "512-371-7478"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "9693",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "10883",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N1732",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "TX",
            "license": "F9289",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro-Care Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pro-Active Neurology & Sports Rehab
• Pro-Care Spine Center, PLLC
• Pro-Care Spine Center, PLLC
• Proactive MD TX Professional Corporation
• Procare Direct Access PLLC
• Procare Internal Medicine Associates, PLLC

• Internal Medicine Physician in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.