Healthcare Provider Details

I. General information

NPI: 1427617554
Provider Name (Legal Business Name): SBH TEXAS PHYSICIANS SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 TOURNAMENT DR
MEMPHIS TN
38125-8906
US

IV. Provider business mailing address

8295 TOURNAMENT DR STE 201
MEMPHIS TN
38125-8913
US

V. Phone/Fax

Practice location:
  • Phone: 901-969-3100
  • Fax:
Mailing address:
  • Phone: 901-969-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA LOVELACE-GALLO
Title or Position: CORPORATE COMPLIANCE COORDINATOR
Credential:
Phone: 901-969-3111