MEDICARE: HOLDING SPACE PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	422778	OTHER		MEDICARE ID

General Provider Information

NPI Number	:	1548641640
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLDING SPACE PLLC

Provider Business Mailing Address
First Line	:	2161 NW MILITARY HWY STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 NW MILITARY HWY STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1844
Country	:	US
Telephone Number	:	210-920-5808
Fax Number	:

Authorized Official
Title or Position	:	MEMBER MANAGER
Name	:	COLIN LIM
Credential	:
Telephone Number	:	210-920-5808

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	12/17/2015

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Directions to “HOLDING SPACE PLLC ” Practice Location

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