NPIMap

Organization Active NPI

Vidamor Medical

  • Multi-Specialty Clinic/Center
  • Boerne, TX
National Provider Identifier
1992314744
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
VIDAMOR MEDICAL
Practice address
107 Reed Rd
Boerne, TX 78006-8605
Phone
(210) 393-2111
NPI assigned
Jul 28, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Authorized official

Name
Mr. Andres Ibarra
Title
Secretary
Phone
(830) 282-1544

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

107 Reed Rd
Boerne, TX 78006-8605

Mailing address

107 Reed Rd
Boerne, TX 78006-8605
Phone (830) 282-1544

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1595894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1992314744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 REED RD",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780068605",
            "telephone_number": "830-282-1544",
            "fax_number": "830-319-9192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 REED RD",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780068605",
            "telephone_number": "210-393-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDAMOR MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-28",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "IBARRA",
        "authorized_official_first_name": "ANDRES",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "830-282-1544",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boerne, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.