Healthcare Provider Details

I. General information

NPI: 1275203929
Provider Name (Legal Business Name): SOMATUS WHOLE CARE CENTER OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 GUADALUPE ST STE 260
AUSTIN TX
78705-5654
US

IV. Provider business mailing address

1861 INTERNATIONAL DR STE 600
MC LEAN VA
22102-4420
US

V. Phone/Fax

Practice location:
  • Phone: 571-992-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICIA J PALMER
Title or Position: AUTHORIZED OFFICIAL, SOMATUS, INC.
Credential:
Phone: 202-236-7061