NPIMap

Organization Active NPI

Micaby Medical,PLLC

  • Nephrology Physician
  • San Antonio, TX
National Provider Identifier
1902422785
Registry record updated Oct 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
MICABY MEDICAL,PLLC
Doing business as
Micaby Medical,PLLC
Practice address
10730 Potranco Rd Ste 122-507
San Antonio, TX 78251-3327
Phone
(210) 858-7604
Fax
(210) 888-0383
NPI assigned
Jun 17, 2020
Last updated
Oct 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2020

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

Authorized official

Name
Dr. Hezekiah Oluwarotimi Sobamowo, MDNPI 1205141884
Title
President
Phone
(615) 397-0896

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X Primary

Addresses

Primary practice location

10730 Potranco Rd Ste 122-507
San Antonio, TX 78251-3327

Mailing address

1222 McCullough Ave Ste 101
San Antonio, TX 78212-4812
Phone (210) 858-7604

Other names 1

  • MICABY MEDICAL,PLLC Doing business as

National Provider Directory

National Provider Directory

Locations

10730 Potranco Rd
Ste 122507
San Antonio, TX 78251
Phone (615) 397-0896

1222 McCullough Ave
#101
San Antonio, TX 78212
Phone (210) 858-7604

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1592352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1902422785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 MCCULLOUGH AVE STE 101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782124812",
            "telephone_number": "210-858-7604",
            "fax_number": "210-888-0383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730 POTRANCO RD STE 122-507",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782513327",
            "telephone_number": "210-858-7604",
            "fax_number": "210-888-0383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICABY MEDICAL,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-17",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A",
        "authorized_official_last_name": "SOBAMOWO",
        "authorized_official_first_name": "HEZEKIAH",
        "authorized_official_middle_name": "OLUWAROTIMI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-397-0896",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MICABY MEDICAL,PLLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MICABY MEDICAL,PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.