Healthcare Provider Details

I. General information

NPI: 1760175483
Provider Name (Legal Business Name): SWSA VBC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 SOUTHWEST FWY STE 810
HOUSTON TX
77074-1811
US

IV. Provider business mailing address

13811 MURPHY RD
STAFFORD TX
77477-4903
US

V. Phone/Fax

Practice location:
  • Phone: 713-772-1200
  • Fax: 713-255-6315
Mailing address:
  • Phone: 713-772-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOYCE CARPENTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 713-255-6355