Healthcare Provider Details

I. General information

NPI: 1679803001
Provider Name (Legal Business Name): OSCEOLA M EVANS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SCHOFIELD RD
FORT SAM HOUSTON TX
78234-7577
US

IV. Provider business mailing address

615 E HOUSTON ST STE 239
SAN ANTONIO TX
78205-2001
US

V. Phone/Fax

Practice location:
  • Phone: 210-808-2585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007664
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: